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Asociación Mexicana de Gastroenterología

2005, Number 2

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Rev Gastroenterol Mex 2005; 70 (2)

Peritoneal and intestinal tuberculosis: An ancestral disease that poses new challenges in the technological era. Case report and review of the literature

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

Language: Spanish
References: 70
Page: 169-179
PDF size: 145.16 Kb.


ABSTRACT

Tuberculosis is a public health problem. The most common presentation is pulmonary disease. The diagnosis of any extrapulmonary forms are quite difficult. Clinical manifestations of gastrointestinal tuberculosis are non-specific and compatible with pathologies such as inflammatory bowel disease, advanced ovarian cancer, deep mycosis, yersinia infection and amebomas. Abdominal form is located at 6th place of the extrapulmonary forms, after lymphatic, genitourinary, osteoarticular, miliary and meningeal infections. Eventually, 25 to 75% of patients with abdominal tuberculosis will require surgery. These procedures should be limitated with the purpose to preserve small bowel. Resection should be limitated for complicated cases. The surgical indications include: Intestinal occlusion (15-60%), perforation (1-15%), abscesses and fistulas (2-30%) and hemorrhage (2%). Conclusions: In most of the cases, the diagnosis of peritoneal or intestinal tuberculosis is made during a laparoscopy or laparotomy even during surgery performed by different purposes. Excessive manipulation of the intraabdominal organs may produced unexpected bowel lesions, increasing morbidity and mortality. Medical treatment is highly effective in the resolution of moderate complications such as bowel obstruction. Resectional procedures should be reserved for complications like perforation, bleeding or stenosis non-suitable for stricturoplasty.


REFERENCES

  1. Van Soolingen D, Hoogenboezem PEW, De Hass PWM, et al. A novel pathogenic taxon of the Mycobacterium tuberculosis complex, Canetti: Characterization of an exceptional isolated from Africa. Int J Syst Bacteriol 1997; 47: 1236-45.

  2. Editorial. The global challenge of tuberculosis. Lancet 1994; 34: 277-9.

  3. Bhargawa DK, Tandon HD, Chawla TC, Shriniwas S, Tandon BN, Kapur BML. Diagnosis of ileocecal and colonic tuberculosis by colonoscopy. Gastrointest Endosc 1985; 31: 68-70.

  4. Corbett EL, Watt CJ, Walker N, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 2003; 163: 1009-21.

  5. Raviglione MC, Snider Dee Jr, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 1995; 273: 220-6.

  6. Metha JB, Dutt A, Harvill L, et al. Epidemiology of extrapulmonary tuberculosis: a comparative analysis with pre-AIDS era. Chest 1991; 99: 1134-8.

  7. Shafer RW, Edlin BR. Tuberculosis in patients infected with human immunodeficiency virus: perspective on the past decade. Clin Infect Dis 1996; 22: 683-704.

  8. Marshall JB, Tuberculosis of the gastrointestinal tract and peritoneum. AM J Gastroenterol 1993; 88: 989-99.

  9. Acharya SK, Tandon BN. Abdominal tuberculosis. In: Watters KAK, Kiire CF (Eds.). Gastroenterology in the Tropics and Subtropics. London: Macmillan; 1995, pp. 85-102.

  10. Jakubowski A, Elwood RK, Enarson DA. Clinical features of abdominal tuberculosis. J Infect Dis 1988; 158: 687-92.

  11. Tan D, Fein PA, Jorden A, et al. Successful treatment of tuberculous peritonitis while maintaining patient on CAPD. Adv Periton Dial 1991; 7: 102-4.

  12. Horvath KD, Whelan RL. Intestinal tuberculosis: Return of an old disease. Am J Gastroenterol1998; 93: 692-6.

  13. Rosengarth TK, Coppa GF. Abdominal mycobacterial infections in immunocompromised patients. Am J Surg 1990; 159: 125-31.

  14. Watters DAK. Surgery for tuberculosis before and after human immunodeficiency virus infection. A tropical perspective. Br J Surg 1997; 84: 8-14.

  15. Sheerman S, Rohwedder JJ, Ravikrishnan KP, et al. Tuberculous enteritis and peritonitis: report of 36 general hospital cases. Arch Intern Med 1980; 140: 506-8.

  16. Klimach OE, Ormerod LP. Gastrointestinal tuberculosis: A retrospective review of 109 cases in a district general hospital. Q J Med 1985; 56: 569-78.

  17. Chen, Caho, Shyu, et al. Isolated liver abscesses with multiple hyperechoic masses on ultrasound: a case report and review of the literature. Liver Int 2003; 23: 346-50.

  18. Fernández del Castillo C, González Ojeda A, Reyes E. et al. Tuberculosis of the pancreas. Pancreas 1990; 5: 693-6.

  19. Franco C, Leonard M, Jurado R, Blumberg H, Smith R. Tuberculosis of the pancreas: Report of two cases and review of the literature. Am J Med Sci 2002; 323: 54-8.

  20. Gilinsky NH, Marks IN, Kottler RE, et al. Abdominal tuberculosis: 10 year review. S Afr Med J 1983; 64: 849-57.

  21. Bhargava DK, Shriniwas, Chopra P, et al. Peritoneal tuberculosis: Laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol 1992; 87: 109-1.

  22. Manohar A, Simjee AE, Haffejee AA, et al. Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period. Gut 1990; 31: 1130-2.

  23. Lisehora GB, Peters CC, Lee YTM, Barcia PJ. Tuberculous peritonitis-do not miss it. Dis Colon Rectum 1996; 39: 394-9.

  24. Bayramicli Oya Uygur, Dabak GUI, Dabak Resat. A clinical dilemma: Abdominal tuberculosis. World J Gastroenterol 2003; 9: 1098-101.

  25. Groutz A, Carmon E, Gat Andrea. Peritoneal tuberculosis versus advanced ovarian cancer: a diagnostic dilemma. Obstet Gynecol 1998; 91: 868.

  26. Borhanmanesh F, Hekmat K, Vaezzadeh K, Rezai HR. Tuberculous peritonitis: Prospective study of 32 cases in Iran. Ann Intern Med 1972; 76: 567-72.

  27. Miranda P, Jacobs A, Roseff L. Pelvic tuberculosis presenting as an asymptomatic pelvic mass with rising CA-125 levels: A case report. J Reprod Med 1996; 41: 273-5.

  28. Bilgin, TI, Karabay AI, Dolar E, Develioglu OHI. Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: A series of 10 cases. Int J Gynecol Cancer 2001; 11: 290-4.

  29. Dwivedi M, Misra SP, Misra V, et al. Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Am J Gastroenterol 1990; 85: 13-5.

  30. Lope CR, Joglar GSM, Romero FP. Laparoscopic diagnosis of tuberculous ascites. Endoscopy 1982; 14: 178-9.

  31. Menzies RI, Fitzgerald JM, Mulpeter K, Laparoscopic diagnosis of ascites in Lesotho. Br Med J 1985; 291: 473-5.

  32. Voigt MD, Trey C, Lombard C, Kalvaria I, Berman P, Kirsch RE. Diagnostic value of ascites adenosine deaminase in tuberculous peritonitis. Lancet 1989; 751-3.

  33. Reddy KR, DiPrima RE, Raskin JB, et al. Tuberculous peritonitis: Laparoscopic diagnosis of an uncommon disease in the United States. Gastrointest Endosc 1988; 34: 422-6.

  34. Shukla HS, Bhatia S, Naitrani YP, et al. Peritoneal biopsy for diagnosis of abdominal tuberculosis. Postgrad Med J 1982; 58: 226-8.

  35. McGee GS, Lester WF, Potts J, et al. Gastrointestinal tuberculosis; resurgence of an old pathogen. Am Surg 1989; 55: 16-19.

  36. Morgante PE, Gandara MA, Sterle E. The endoscopic diagnosis of colonic tuberculosis. Gastrointest Endosc 1989; 35: 115-18.

  37. Rosengarto TK, Coppa GF. Abdominal mycobacterial infections in immunocompromised patients. Am J Surg 1990; 159: 125-30.

  38. Kapoor VK. Abdominal tuberculosis. Postgrad Med J 1998; 74: 459-67.

  39. Sherman S, Rohwedder JJ, Ravikrishnan KP, et al. Tuberculous enteritis and peritonitis: Report of 36 general hospital cases. Arch Intern Med 1980; 140: 506-8.

  40. Kalvari I, Kottler Re, Marks IN. The role of colonoscopy in the diagnosis of tuberculosis. J Clin Gastroenterol 1988; 10: 516-23.

  41. Pettengell KE, Prie D, Simjee AE. Colonoscopic features of early intestinal tuberculosis: Report of 11 cases. S Afr Med J 1991; 79: 279-80.

  42. Peh WCG. Filiform polyposis in tuberculosis of the colon. Clin Radiol 1988; 39: 534-6.

  43. Anand BS, Schneider Fee, El-Zaatari FAK, et al. Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens. Am J Gastroenterol 1994; 89: 2248-9.

  44. Bhattacharya B, Darak K, Ghosal AG, Roy A, Das S, et. al. Development of a new sensitive and efficient multiplex polymerase chain reaction (PCR) for identification and differentiation of different mycobacterial species. Trop Med & Int Health 2003; 8: 150-7.

  45. Braegger C. New methods to confirm the cause of spontaneous bacterial peritonitis. J Pediatr Gastroenterol Nutr 2003; 37: 213-14.

  46. Lingenfelser T, Zak J, Marks IN, Steyn E, Halkett J, Price SK. Abdominal tuberculosis: still a potentially lethal disease. Am J Gastroenterol 1993; 88: 744-50.

  47. Kedar RP, Shah PP, Shivde RS, Malde HM. Sonographic findings in gastrointestinal and peritoneal tuberculosis. Clin Radiol 1994; 49: 24-9.

  48. Hulnick DH, Megibow AJ, Naidich DP, et al. Abdominal tuberculosis CT evaluation. Radiology 1985; 157: 1999-204.

  49. Hassan I, Brilakis ES, Thompson RL, Que FG. Surgical management of abdominal tuberculosis. J Gastrointest Surg 2002; 6: 862-7.

  50. Balikian JP, Uthman SM, Kabaian HA. Tuberculous colitis. AM J Proctol 1977; 28: 75-9.

  51. British Thoracic Society Research Committee. Short course chemotherapy for tuberculosis of lymph nodes: a controlled trial. BMJ 1985; 290: 1106-8.

  52. Donald PR, Schoeman JF, Van Zyl LE, De Villiers JN, Pretorius M, Springer P. Intensive short course chemotherapy in the management of fuberculosis meningitis. In J Tuberc Lung Dis 1998; 2: 704-11.

  53. World Health Organization. Global Tuberculosis Programme. Treatment of tuberculosis: guidelines for national programmes, 3rd edt. (WHO/CDS/TB/2003.13). Geneve: WHO; 2003.

  54. Centers for Disease Control and Prevention. Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations. MMWR Recomm Rep 1998; 47(RR-20): 1-58.

  55. Burman WJ, Jones Bee. Treatment of HIV-related tuberculosis in the era of effective antiretroviral therapy. Am J Resp Crit Care Med 2001; 164: 7-12.

  56. Munsiff SS, Fujiwara PI. Treatment of tuberculosis in patients taking antiretrovirals (erratum AIDS Reader 2000; 10: 206). AIDS Reader 2000; 10: 102-8.

  57. Des Prez RM, Heim CR. Mycobacterium tuberculosis. In: Dell GL, Douglas RG Jr, Bennett Jee, Eds. Principles an practice of infectious diseases, 3rd ed. New York: Churchill- Livingstone; 1990, pp. 1877-906.

  58. Kita R, Kim E, Yukwa K, et al. Treatment of intestinal tuberculosis. Gastroenterol Jpn 1977; 12: 363-7.

  59. Vaidaya MG, Sodhi JS. Gastrointestinal tract tuberculosis. A study of 102 cases including 58 hemicolectomies. Clin Radiol 1976; 189-95.

  60. Das P, Shukla HS. Clinical diagnosis of abdominal tuberculosis. Br J Surg 1976; 63: 941-6.

  61. Sherman S, Rohwedder JJ, Ravikrishnan KP, et al. Tuberculous enteritis and peritonitis: report of 36 general hospital cases. Arch Intern Med 1980; 140: 506-8.

  62. Singh MK, Arunabh, Kappor VR. Tuberculosis of the appendix-a report of 17 cases and a suggested aetiopathological classification. Postgrad Med J 1987; 63(744): 855-7.

  63. Haddad FS, Ghossain A, Azuaya E, et al. Abdominal tuberculosis. Dis Colon Rectum 1987; 30: 724-35.

  64. Pujari BD. Modified surgical procedures in intestinal tuberculosis. Br J Surg 1979; 66: 180-1.

  65. Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol 1977; 67: 324-37.

  66. Anand BS, Nanda R, Schdev GK. Response of tuberculous stricture to antituberculous treatment. Gut 1988; 29: 62-9.

  67. Katariya RN, Sood S, Rao PG, et al. Stricture–plasty for tubercular strictures of the gastrointestinal tract. Br J Surg 1977; 64: 496-8.

  68. Pujari BD. Modified surgical procedures in intestinal tuberculosis. Br J Surg 1979; 66: 180-1.

  69. Anscombe AR, Keddie NC, Schofield PF. Ceacal tuberculosis. Gut 1967; 8: 337-43.

  70. Palmer KR, Patil DH, Basran GS, et al. Abdominal tuberculosis in urban Britain: A common disease. Gut 1985; 26: 1296-1305.




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