What Is Peritoneal Tuberculosis?

Tuberculous peritonitis is a chronic, diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis. The infection can be caused by the direct spread of hepatic tuberculosis or the spread of blood. The former is more common, such as intestinal tuberculosis, mesenteric lymph tuberculosis, tubal tuberculosis, etc., can be the direct primary lesions of this disease. It is more common among young and middle-aged women, and slightly more than men, ranging from 1.2 to 2.0: 1. More women than men may be due to retrograde infection of pelvic tuberculosis.

Basic Information

English name

tuberculousperitonitis

Visiting department

Gastroenterology

Multiple groups

Young women

Common symptoms

Burnout, fever, bloating, abdominal pain, chills, sudden high fever, abdominal mass

Causes of tuberculous peritonitis

Mycobacterium tuberculosis belongs to the genus Mycobacterium of the family Actinomycetes, and is a pathogenic acid-resistant bacterium, which is mainly divided into human, cattle, bird, and mouse types. Those who are pathogenic to humans are mainly human-type bacteria, and bovine-type bacteria are rarely infected. Both human and bovine tuberculosis strains are obligate parasites, with humans and cattle as natural hosts, respectively. Both are equally pathogenic to humans, monkeys and guinea pigs. The resistance of tuberculosis bacteria to drugs can be formed by the development of congenital drug-resistant bacteria in the flora. It can also quickly develop resistance to the drug by using an anti-tuberculosis drug alone, that is, to obtain drug-resistant bacteria. Drug-resistant bacteria can cause difficulties in treatment and affect efficacy.

Clinical manifestations of tuberculous peritonitis

Most of the onset of this disease is slow, but the number of acute onset is also not uncommon. The main symptoms are burnout, fever, bloating, and abdominal pain, as well as those who have chills and sudden onset of high fever. Mild cases begin to show concealment.

Whole body performance

Fever and night sweats are the most common. Fever types are mostly low and moderate, and some patients are exaggerated. Exudative, cheese-like cases or patients with severe extra-abdominal tuberculosis can be left with fever, severe night sweats, and severe cases with malnutrition such as anemia, weight loss, edema, angular cheilitis, and vitamin A deficiency. Infertile women are more common among women of childbearing age.

Abdominal pain

Most patients can have varying degrees of abdominal pain, most of which are persistent dull or dull pain, and the pain is mostly located around the umbilicus, lower abdomen, and sometimes the entire abdomen. When patients have acute abdomen, acute peritonitis caused by rupture of abdominal tuberculosis lesions should be considered. Tuberculous peritonitis rarely has perforation.

3. Bloating and ascites

Most patients have a feeling of bloating, which can be caused by symptoms of tuberculosis or intestinal dysfunction associated with peritonitis. Patients may develop ascites, which is more common in small and moderate amounts. Mobility dullness can occur when there is more ascites.

4. Flexible abdominal wall

Flexibility is a clinical feature of adhesive tuberculous peritonitis. The vast majority of patients have varying degrees of tenderness, generally mild, a few tenderness is obvious and rebound pain, the latter is more common in cheese type.

5. Abdominal mass

Adhesive and cheese patients can often touch the mass in the abdomen, mostly in the lower mid-abdomen. The masses vary in size, with uneven edges, and are sometimes horizontally shaped or nodular, with slight tenderness.

6. Other

Diarrhea may occur in some patients, and constipation is more common in patients with adhesions. Sometimes diarrhea and constipation occur alternately. Hepatomegaly can be caused by fatty liver or liver tuberculosis caused by malnutrition. Such as intestinal obstruction, peristaltic waves can be seen, hyperactive bowel sounds.

Tuberculous peritonitis

Blood image and erythrocyte sedimentation

Some patients have varying degrees of anemia, white blood cell counts can increase in those with acute spread of celiac tuberculosis lesions, cheese type, and secondary infections, and the rate of erythrocyte sedimentation and erythrocyte sedimentation has mostly increased. ESR can also be used as a simple indicator of disease activity.

2. Tuberculin test

Those who are strongly positive for the tuberculin test can help diagnose the disease, but miliary tuberculosis or severe patients can be negative.

3. Ascites check

In recent years, it has been advocated that the diagnosis of infectious ascites should increase the experimental diagnostic indicators. Ascites glucose <3.4mmol / L, pH <7.35 indicates bacterial infection, especially when the activity of adenosine deaminase in ascites is increased, suggesting tuberculous peritonitis. The positive rate of ascites animal inoculation can reach above 50%.

4. Gastrointestinal X-ray

Barium meal examination, if found intestinal adhesions, intestinal tuberculosis, intestinal fistula, extra-intestinal lump and other phenomena, is of auxiliary value for the diagnosis of this disease. The plain film of the abdomen sometimes shows calcification, and the mesentery lymph nodes are calcified.

5. Laparoscopy

Patients with extensive peritoneal adhesions are contraindicated. Applicable to patients with free ascites. Laparoscopy can see gray or white nodules scattered or gathered on the peritoneum, omentum and visceral surface. Biopsy can confirm the diagnosis.

Diagnosis of tuberculous peritonitis

1. Unexplained fever, lasting more than two weeks, accompanied by night sweats, ineffective with general antibiotic treatment.

2. People who have close contact with tuberculosis or have other parenteral tuberculosis.

3. The abdominal wall is flexible, with ascites or palpable mass.

4. Erythrocyte sedimentation rate, ascites are exudates.

5. X-ray examination of gastrointestinal barium meal found signs of intestinal adhesions.

Differential diagnosis of tuberculous peritonitis

1. Differentiation from diseases with ascites

(1) Decompensation of liver cirrhosis, patients with abnormal liver function, portal hypertension, hypersplenism, liver disease face and spider nevus.

(2) Cancerous ascites is mostly bloody ascites. Repeated ascites examination can find tumor cells.

(3) Both constrictive pericarditis and hepatic vein obstruction syndrome can produce ascites, but both have corresponding pericardial and liver signs.

2. Identification of diseases with abdominal pain as the main symptom

Should be distinguished from Crohn's disease, etc., combined with intestinal obstruction, intestinal fistula and peritonitis, should be distinguished from other causes of acute abdomen.

3. Identification of diseases with abdominal masses as the main signs

This disease is sometimes confused with malignant tumors such as colon cancer and ovarian cancer, and attention should be paid to identification.

Tuberculous peritonitis treatment

1. Drug therapy is still based on the principle of sufficient quantity and combination. The course of treatment is at least 18 months.

2. For patients with ascites, after the ascites is released, injecting dexamethasone acetate and other drugs into the abdominal cavity can accelerate the absorption of ascites and reduce adhesions.

3. For patients with severe hematogenous dissemination or severe TB toxemia, adrenal glucocorticoids can be added on the basis of effective antituberculosis treatment, but it should not be used for a long time.

4. Most patients may have been treated with anti-TB drugs. Therefore, such patients should choose drugs that have not been used or used rarely before, and formulate a combined drug regimen.

5. Feasibility of surgical treatment for intestinal obstruction, intestinal fistula, and suppurative peritonitis. When it is indeed difficult to distinguish from intra-abdominal tumors, a laparotomy is feasible.