ORIGINAL ARTICLES   

Minerva Chirurgica 2007 February;62(1):25-31

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: Italian

Abdominal tuberculosis: clinical features, diagnosis and role of surgery

Leone V., Misuri D., Fazio C., Cardini S.

U.O. di Chirurgia Generale Ospedale S. Maria Nuova - ASL 10, Firenze

Aim. Nowadays the incidence of tuberculosis is increasing in some population groups (subjects immigrated from developing countries, affected from HIV infection, or undergoing immunosuppressive therapy) and to the development of multidrug-resistance. The clinical manifestations, routine laboratory and radiographic analyses of abdominal tuberculosis are nonspecific and surgery plays a fundamental role because 25-75% of such patients are operated.
Methods. Six patients, 4 male and 2 female (age 23-62 years) underwent laparotomy or laparoscopy. Five patients were not European, 1 was Italian. The surgical indications were: intestinal occlusion in 3 patients; perforation in 1 patient; peritonitis in 2 patients.
Results. The most frequent clinical manifestations were pyrexia, weight loss, anemia, ascites. Chest X-ray was normal in all patients. All patients were found ARB-negative in sputum and in ascitic fluid, while 1 was positive to culture of sputum and 3 of ascitic fluid. In all patients histopathologic examination showed typical findings of tuberculosis.
Conclusion. The surgical indication is made for diagnostic aim or due to the presence of complications. Laparoscopy is the gold standard in the diagnosis,since it allows whole exploration of abdomen and taking of sample for biopsy and ascitic fluid to find micobacterium. In fact, abdominal tubercolosis is a paucibacillar disease and rarely it is possible to demonstrate the direct presence of M. Tuberculosis, but nowadays the methods of the genome amplification allow to demostrate the sequence of the chromosomial DNA of M. Tuberculosis from small fragments of bioptic material.