دانلود رایگان مقاله انسداد روده و پنوماتوز روده عامل اصلی پریتونیت سلی

Summary

Tuberculous peritonitis (TBP) is a continuing problem in populations with high prevalence of tuberculosis and is difficult to diagnose early. Here, we report a case of confirmed TBP that presented as intestinal ileus and pneumatosis intestinalis. The 79-year-old woman had a history of atrial fibrillation, chronic ischemic heart disease, and chronic renal failure (chronic kidney disease, stage V). She complained of abdominal fullness and pain for 1 week prior to hospitalization. A computed tomography (CT) scan revealed pneumatosis intestinalis. Laparoscopic surgery was performed, and multiple whitish nodules covering the peritoneum were discovered. Biopsy results were consistent with caseating granulomatous inflammation. A modified anti-tuberculosis regimen (isoniazid, 300 mg daily; rifampicin 600 mg daily; ethambutol 800 mg three times per week; and pyrazinamide 1200 mg three times per week) was initiated, stabilizing the condition of the patient. The total duration of anti-tuberculosis therapy was 12 months, with patient condition gradually improving to normal. The elderly, uremic patients recovered fully after the modified anti-tuberculosis regimen for 12 months. For clinical practice, we developed a decision-making algorithm for patients suspecting TBP.

Discussion

To our knowledge, this is the first case report of TBP presenting as intestinal obstruction and pneumatosis intestinalis in central Taiwan. Invasive techniques following peritoneal biopsy are usually needed to confirm TBP [7]. Sotoudehmanesh et al [8] reported diagnosing 50 (74%) patients with laparotomy and laparoscopy [8]. Laparoscopic examination is the most important method of diagnosis, and our experience is the same as that reported by Bhargava et al [5]. Patients with TBP may present with fever, abdominal pain, abdominal distension, and weight loss. Sanai et al [9] reported the cumulative data of clinical features, various diagnostic tests, and image findings from 39 TBP studies, finding that the laparoscopic method was the most sensitive for diagnosing TBP (Table 1) [9]. The most common complication of TBP is intestinal obstruction, as in the present case. Early diagnosis and treatment are expected to decrease TBP-related mortality and morbidity.