NGakoutou R, Nemian M, Allawaye L, Joseph M, Ahmat A, Ali Bolti, Adjougoulta K, Mihimit A, Ali M
Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena).
Mali Med. 2022;37(1):16-20.
Peritoneal tuberculosis is not uncommon in Chad. Its diagnosis of certainty is difficult and is based on the analysis of ascites fluid and abdominal ultrasound. Our aim was to contribute to the study of the various clinical, diagnostic and progressive aspects of peritoneal tuberculosis in the internal medicine department of the HGRN.
This is a retrospective and prospective study spread over 39 months covering the period from January 2014 to March 2017 including all patients hospitalized for peritoneal tuberculosis in the internal medicine department of the HGRN. The diagnosis was made, on a bundle of anamnestic, clinical, ultrasound, cytological and evolutionary arguments.
During the study period, 69 patients were included, or 9.77% of all hospital admissions. The average age was 42 years (range 18 to 83 years). The female sex represented 52.2% of the cases. The main reasons for hospitalization were ascites (87% of cases), associated with fever (92.5% of cases). The clinical signs were dominated by abdominal pain, deterioration of general condition and transit disorders. The ascites fluid was citrus yellow, rich in lymphocytes (81.6% of cases) and protein (94.2% of cases). Abdominal ultrasound, performed in all patients, demonstrated ascites with deep, mesenteric lymphadenopathy, portal in 62.3% of cases and compartmentalized in 37.7% of cases. Tuberculosis treatment was started in all patients and the outcome was favorable in 65.2% of cases. We deplored 20.3% mortality; all were patients who were severely immunosuppressed with HIV.
Peritoneal involvement in tuberculosis is common in Chad. The diagnosis is not always easy, but the clinic associated with the exudative and lymphocytic characters of the ascites fluid as well as the abdominal ultrasound are elements which can direct towards a peritoneal localization of tuberculosis. The course is generally favorable under early treatment and well conducted.
腹膜结核在乍得并不罕见。其确切诊断较为困难，需基于腹水分析和腹部超声检查。我们的目的是为乍得恩贾梅纳大学教学医院内科腹膜结核的各种临床、诊断及进展方面的研究提供帮助。
这是一项回顾性和前瞻性研究，历时39个月，涵盖2014年1月至2017年3月期间，纳入了乍得恩贾梅纳大学教学医院内科所有因腹膜结核住院的患者。诊断基于一系列病史、临床、超声、细胞学及病情演变依据。
研究期间，共纳入69例患者，占所有住院患者的9.77%。平均年龄为42岁（范围18至83岁）。女性占病例的52.2%。主要住院原因是腹水（87%的病例），伴有发热（92.5%的病例）。临床症状以腹痛、全身状况恶化及肠道功能紊乱为主。腹水呈橙黄色，富含淋巴细胞（81.6%的病例）和蛋白质（94.2%的病例）。所有患者均进行了腹部超声检查，显示有腹水，伴有深部肠系膜淋巴结肿大，62.3%的病例有门静脉受累，37.7%的病例有腹水分隔。所有患者均开始抗结核治疗，65.2%的病例治疗结果良好。我们遗憾地记录到20.3%的死亡率；所有死亡患者均为合并严重免疫抑制的艾滋病患者。
在乍得，结核累及腹膜较为常见。诊断并非总是容易，但结合腹水的渗出性和淋巴细胞特征的临床症状以及腹部超声检查结果有助于判断结核的腹膜定位。早期且规范的治疗通常预后良好。
