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Asociación Mexicana de Gastroenterología

2005, Número 2

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Rev Gastroenterol Mex 2005; 70 (2)


Tuberculosis peritoneal e intestinal: una enfermedad ancestral que impone nuevos retos en la era tecnológica. Informe de un caso y revisión de la literatura

Farías LOA, López RMKL, Morales AJM, Medina QM, Buonocunto VG, Ruiz CIE, González OA

Idioma: Español
Referencias bibliográficas: 70
Paginas: 169-179
Archivo PDF: 145.16 Kb.


RESUMEN

La tuberculosis continúa siendo un problema de salud pública, la forma clínica más común es la enfermedad pulmonar, las formas extrapulmonares son de difícil diagnóstico. Las manifestaciones clínicas son inespecíficas y compatibles con otras patologías como enfermedad inflamatoria intestinal, cáncer de ovario avanzado, micosis profundas, infección por yersinia y amebomas. La afección del peritoneo ocupa el sexto lugar, después de los ganglios linfáticos, genitourinaria, osteoarticular, miliar y meníngea. Eventualmente, 25 a 75% de los pacientes con tuberculosis abdominal requerirán cirugía, ésta debe ser un procedimiento conservador y reservándose las resecciones intestinales para casos complicados. La oclusión intestinal representa 15-60% de las complicaciones, la perforación intestinal 1-15%, abscesos y fístulas 2-30% y finalmente hemorragia 2%. Conclusiones: en una gran proporción de pacientes el diagnóstico de tuberculosis peritoneal o intestinal se realiza durante una laparoscopia o laparotomía o incluso cuando se realizan procedimientos con otros propósitos. La excesiva manipulación de órganos intraabdominales puede producir lesiones intestinales inadvertidas. Estas complicaciones pueden aumentar la morbilidad y mortalidad. El tratamiento médico es altamente efectivo en la resolución de complicaciones de moderada gravedad como la obstrucción intestinal. Los procedimientos resectivos deberían reservarse sólo para complicaciones como perforación, hemorragia o cuando la estenosis no es adecuada para la plastia.


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