Laparoskopi ile Tanı Konulan Tüberküloz Peritonitli Çocuk Vaka

Year 2017, , 84 - 88, 01.04.2017

Manolya Acar Cemile Ayşe Odacılar Selda Hançerli Törün Murat Sütçü Başak Erginel Emine Çalışkan Hüseyin Özbey Nuran Salman Ayper Somer

https://doi.org/10.5222/j.child.2017.084

Abstract

Amaç: Tüberküloz peritonit TBP ender bir akciğer dışı tüberküloz formudur. Bununla birlikte, TBP tanısı koymak çocuklarda özellikle zordur. Burada, batında asit saptanıp, laparoskopik olarak TBP tanısı konulmuş çocuk vaka sunulmuştur. Vaka sunumu: Öncesinde yakınmasız 3 yaşında kız hasta yeni gelişen ateş ve karın ağrısı nedeniyle getirildi. Fizik muayenede batın distansiyonu, yaygın hassasiyeti ve perküsyonla yer yer matite mevcuttu. Batın ultrasonografi incelemesinde multipl septasyonlar içeren yaygın sıvı saptanması üzerine yapılan parasentez mayii eksuda vasfında saptandı. Mikroskobik incelemesinde, bol polimorfnüveli lökosit gözlendi. Antibiyoterapi sonrası kontrol periton sıvısında lenfosit hâkimiyetinde hücre sebat ediyordu. Periton sıvısında aside dirençli bakteri ARB görülmedi, tüberküloz TB polimeraz zincir reaksiyonu negatif sonuçlandı, sıvı kültürü steril kaldı. Sitopatolojik incelemesinde malinite düşündürecek bulgu saptanmadı. Diagnostik laparoskopi, ön planda TB lehine değerlendirildi. Batın sıvısında adenozin deaminaz düzeyi yüksek bulunan hastaya izoniazid, rifampisin, pirazinamid ve etambutol içeren 4’lü antitüberküloz tedavi başlandı. Antitüberküloz tedavisinin ikinci ayında karın çevresinde belirgin gerileme saptanan hastanın tedavisi izoniazid ve rifampisin olarak planlandı ve hasta izleme alındı. Sonuç: Tüberküloz peritonit tanısında eksploratif laparoskopi ve ek olarak periton sıvısında adenozin deaminaz ADA yüksekliği oldukça değerlidir.

Keywords

Tuberküloz peritonit, laparoskopi, adenozin deaminaz

A Case of Tuberculous Peritonitis Diagnosed by Way of Laparoscopy

Abstract

Objective: Tuberculous peritonitis TBP is a rare form of extrapulmonary tuberculosis. The diagnosis of TBP is particularly challenging in children. Herein, we present a child who had been admitted with ascites and diagnosed as TBP by way of laparoscopy. Case report: A previously healthy 3-year-old girl was presented with newly onset fever and abdominal pain. She had abdominal distention and generalized tenderness on palpation. Abdominal percussion revealed dullness on nonspesific locations. Abdominal ultrasonography showed diffuse ascites with multiple septations, and paracenthesis performed detected exudative material with plenty of polmorphonuclear leukocytes. She was started on antibiotherapy. Lymphocytic pleocytosis persisted on control peritoneal lavage sample. Acid- resistant bacteria were not seen in the peritoneal fluid, tuberculous polymerase chain reaction test and tuberculous cultures were negative. Cytopathologic examination was not suggestive of malignancy. Diagnostic laparoscopy was compatible with TBP. Adenosine deaminase ADA level in peritoneal fluid was increased. She was started on quadruple antituberculous treatment including isoniazid INH , rifampicin RIF , pyrazinamide and ethambutol. On the 2nd month of antituberculous therapy, abdominal circumference showed obvious regression. She continued on INH-RIF therapy and is still being followedup in our outpatient clinic. Conclusion: Explorative laparoscopy and peritoneal fluid ADA level are very helpful in the diagnosis of TBP.

Keywords

Tuberculous peritonitis, laparoscopy, adenosine deaminase

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