Hubbard Grant, Chlysta Walter
Western Reserve Hospital, Department of Surgery, 1900 23rd St, Cuyahoga Falls, OH 44223, USA.
J Clin Tuberc Other Mycobact Dis. 2021 Mar 18;23:100228. doi: 10.1016/j.jctube.2021.100228. eCollection 2021 May.
Tuberculous appendicitis is a rare extrapulmonary manifestation of tuberculosis without clear summarization or consensus on its management.
Case reports were gathered from several online literature databases by searching terms "tuberculosis", "tuberculous", and "appendicitis".Report eligibility criteria: Cases of appendicitis due to identified on operative histology. Exclusion criteria: appendicitis caused by a mycobacterium other than s, and appendiceal tuberculosis identified incidentally during procedures for other reasons.
Thirty four patients were identified. Twenty five patients presented with acute right lower quadrant abdominal pain. Eleven patients described chronic symptoms of tuberculosis (cough, night sweats, or weakness/fatigue). Four patients had a known diagnosis of TB. Seven of 24 cases reported peri-operative chest imaging which demonstrated pulmonary lesions. AFB were present in tissue or fluid samples of 6 patients, and negative in 15 patients. All patients underwent pharmacotherapy on a WHO-recommended anti-tuberculous treatment (ATT) with RIPE or an alternative. The average duration of treatment was 7.2 ± 1.7 months.
Data was gathered from case reports without complete uniformity in diagnostic work-up. The potential for larger scale study is limited due to disease rarity.
Tuberculous appendicitis cannot be diagnosed prior to histologic evaluation. Several data points may suggest the disease on a clinician's differential diagnosis if they present with a combination of the following: born in a country with endemic tuberculosis; chronic cough, weakness/fatigue, or nausea prior to onset of abdominal pain; pulmonary lesions on chest X-ray; white studding of the mesentery or peritoneum in a young patient; positive AFB stain of abdominal fluid or peritoneal tissue.
结核性阑尾炎是一种罕见的肺外结核表现，目前对其治疗尚无明确的总结或共识。
通过搜索“结核病”“结核性”和“阑尾炎”等关键词，从多个在线文献数据库收集病例报告。报告纳入标准：手术组织学确诊为阑尾炎的病例。排除标准：由除结核分枝杆菌以外的其他分枝杆菌引起的阑尾炎，以及因其他原因在手术过程中偶然发现的阑尾结核。
共纳入34例患者。25例患者表现为急性右下腹疼痛。11例患者描述有结核病的慢性症状（咳嗽、盗汗或虚弱/疲劳）。4例患者已知患有结核病。24例患者中有7例报告了围手术期胸部影像学检查，显示有肺部病变。6例患者的组织或液体样本中发现抗酸杆菌，15例患者为阴性。所有患者均接受了世界卫生组织推荐的抗结核治疗（ATT），采用RIPE方案或替代方案。平均治疗时间为7.2±1.7个月。
数据来自病例报告，诊断检查缺乏完全一致性。由于疾病罕见，大规模研究的可能性有限。
在组织学评估之前无法诊断结核性阑尾炎。如果患者出现以下情况组合，一些数据点可能提示临床医生在鉴别诊断时考虑该病：出生在结核病流行国家；腹痛发作前有慢性咳嗽、虚弱/疲劳或恶心；胸部X线显示肺部病变；年轻患者肠系膜或腹膜有白色结节；腹腔积液或腹膜组织抗酸杆菌染色阳性。
