Y M Chen1, P Y Lee, R P Perng. 1. Chest Department, Veterans General Hospital-Taipei, Shih-pai, Taiwan, Republic of China.
Abstract
SETTING: From 1986 to 1992, 27 cases of abdominal tuberculosis were diagnosed in Veterans General Hospital-Taipei, Taiwan, including 21 cases of intestinal tuberculosis and 6 cases of peritoneal tuberculosis. OBJECTIVE: To ascertain the clinical characteristics of abdominal tuberculosis in Chinese patients and the possibility of early clinical diagnosis of abdominal tuberculosis. DESIGN: Clinical features, diagnosis and treatment modality of these 27 cases were reviewed. RESULTS: 22 of the patients (81.5%) had chest X-ray evidence of pulmonary tuberculosis. Only 2 had normal chest X-ray findings. Sputum mycobacterium culture was positive in 14 of 27 patients (51.9%). 20 patients received exploratory laparotomy for the diagnosis and all of the preoperative diagnoses were wrong. The diagnosis was still incorrect or uncertain in 9 cases after laparotomy if no pathological examination was done. Ileocecal area was the most common site of intestinal tuberculosis in our series and 3 of 11 ulcerative types of intestinal tuberculosis died later. CONCLUSION: Due to protean manifestations, the diagnosis of abdominal tuberculosis was frequently misdiagnosed, and particularly as carcinomatosis. The diagnosis should be considered when patients with pulmonary tuberculosis suffer from abdominal discomfort. Exploratory laparotomy is needed in cases suspected of abdominal carcinomatosis without definite diagnosis.
SETTING: From 1986 to 1992, 27 cases of abdominal tuberculosis were diagnosed in Veterans General Hospital-Taipei, Taiwan, including 21 cases of intestinal tuberculosis and 6 cases of peritoneal tuberculosis. OBJECTIVE: To ascertain the clinical characteristics of abdominal tuberculosis in Chinese patients and the possibility of early clinical diagnosis of abdominal tuberculosis. DESIGN: Clinical features, diagnosis and treatment modality of these 27 cases were reviewed. RESULTS: 22 of the patients (81.5%) had chest X-ray evidence of pulmonary tuberculosis. Only 2 had normal chest X-ray findings. Sputum mycobacterium culture was positive in 14 of 27 patients (51.9%). 20 patients received exploratory laparotomy for the diagnosis and all of the preoperative diagnoses were wrong. The diagnosis was still incorrect or uncertain in 9 cases after laparotomy if no pathological examination was done. Ileocecal area was the most common site of intestinal tuberculosis in our series and 3 of 11 ulcerative types of intestinal tuberculosis died later. CONCLUSION: Due to protean manifestations, the diagnosis of abdominal tuberculosis was frequently misdiagnosed, and particularly as carcinomatosis. The diagnosis should be considered when patients with pulmonary tuberculosis suffer from abdominal discomfort. Exploratory laparotomy is needed in cases suspected of abdominal carcinomatosis without definite diagnosis.