Öz
İntroduction: Intraabdominal abscess formation is one of the rare
complications observed after cesarean deliveries although it might be observed
more commonly during emergency c-sections. The most common signs are
postoperative abdominal pain, fever, fatigue, constipation or diarrhea, erythema
at the site of the incision, purulent discharge and dehiscence of the incision.
Recently, there is an increase in the incidence of tuberculosis. Like this, the
incidence of rare forms of extrapulmonary tuberculosis cases like tuberculosis
peritonitis are also showing an increase. The mechanism of development of
peritoneal tuberculosis is still unclear and its diagnosis is difficult due to
nonspecific symptoms.
Case:
The patient who
applied with abdominal pain, fatigue five days after cesarean section had a
re-laparotomy with the diagnosis of postoperative intraabdominal abscess
formation. The clinical recovery after the second operation was slow although
the symptoms regressed with the antibiotic regimen applied postoperatively and
no intraabdominal pathology was detected postoperatively with the imaging
techniques. The patient was diagnosed to have pulmonary tuberculosis with the
detection of acid-resistant bacteria in the bronchoalveolar lavage fluid during
the bronchoscopy performed due to the aggravated pulmonary symptoms of the
patient during the follow-up period. The patient who had full recovery with the
antituberculotic medications had no significant medical history.
Result: The diagnosis and treatment of peritoneal
tuberculosis is delayed due to its symptoms that mimic other pathologies. This
entity must be considered especially in high risk patients and the possibility
of development of a postoperative abscess due to it must be kept in mind. Early
diagnosis will reduce the morbidity and mortality and prevent unnecessary
surgical interventions.
Anahtar Kelimeler
Cesarean section intra-abdominal abscesses peritonitis tuberculosis
Kaynakça
- 1. Duff P. Pathophysiology and management of postcesarean endomyometritis. Obstet Gynecol. 1986 Feb;67(2):269-76.
- 2. Duff P. Diagnosis and Management of Postoperative Infection. Glob libr women's med. 2011, ISSN: 1756-2228; DOI 10.3843/GLOWM.10032.
- 3. Delisle M, Seguin J, Zeilinski D, Moore DL. Paediatric abdominal tuberculosis in developed countries: case series and literature review. Arch Dis Child. 2016;101:253-8.
- 4. Marshall JB. Tuberculosis of gastrointestinal tract and peritoneum. Am J Gastroenterol 1993;88:989-99. 5. Dinler G, Sensoy G, Helek D, Kalayci AG. Tuberculous peritonitis in children: report of nine patients and review of the literature. World J Gastroenterol 2008;21: 7235-7239.
- 6. Forssbohm M, Zwahlen M, Loddenkemper R, Rieder HL. Demographic characteristics of patients with extrapulmonary tuberculosis in Germany. Eur Respir J 2008; 31: 99-105.
- 7. Rowińska-Zakrzewska E. Extrapulmonary tuberculosis, risk factors and incidence. Pneumonol Alergol Pol 2011; 79: 377-378.
- 8. Long S, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases (4th ed). New York: Elsevier Saunders; 2012.
- 9. Cruz AT, Starke JR. Clinical manifestations of tuberculosis in children. Paediatr Respir Rev 2007;8: 107-117.
- 10. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis-presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005;22:685-700.
- 11. Rasheed S, Zinicola R, Watson D, et al. Intra-abdominal and gastrointestinal tuberculosis. Colorectal Disease 2007;9:773-83.
- 12. Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002;12:312-23. 13. Bhargave DK, Shriniwas, Chopra P. Et al. Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol 1992;87:109-12.
- 14. Yancey MK, Clark P, Duff P. The frequency of glove contamination during cesarean delivery. Obstet Gyne¬col 1994;83:538-542.
- 15. Watts DH, Hillier SL, Eschenbach DA. Upper genital tract isolates at delivery as predictors of post-cesar¬ean infections among women receiving antibiotic pro¬phylaxis. Obstet Gynecol 1991;77:287-292.
- 16. Kadanalı A, Karagöz G. Puerperal Infections. Medical Journal of Ümraniye 2012;5;1.
- 17. Uyanıkoğlu H, Uyanıkoğlu A, Büyükfırat E, Gengeç K. Importance of laparoscopic intervention in the differential diagnosis of peritonitis carcinomatosa and tuberculous peritonitis. Turk J Gastroenterol 2017; 28: 528-30.
- 18. Boss JD, Shah CT, Oluwole O, Sheagren JN. TB Mistaken for Ovarian Carcinomatosis Based on an Elevated CA-125. Case Report Med. 2012;2012:215293. Epub 2012 Feb 20.
Öz
Giriş:
Acil alınan vakalarda daha sık görülse de sezaryen doğumlarda (SD)
intraabdominal apse nadir komplikasyonlardandır. Postoperatif karın ağrısı,
ateş, halsizlik, kabızlık/ishal, insizyon hattında kızarıklık, pürülan akıntı
ve insizyon hattında açılma gibi belirtileri olabilir. Günümüzde pulmoner tüberküloz
sıklığı artmaktadır. Bununla birlikte tüberküloz peritonit (TP) gibi
ekstrapulmoner tüberküloz nadir görülmektedir. Tam olarak hangi mekanizma ile
geliştiği bilinmeyen TP’in, nonspesifik semptomlar nedeniyle tanısı zordur.
Tanıda öncelikle hastalığın düşünülmesi önemlidir.
Vaka:
Beş gün önce Sezaryen Doğum (SD) yapan, sonrasında karın ağrısı, halsizlik
şikayetiyle başvuran hastaya postoperatif intraabdominal apse tanısıyla
relaparatomi yapıldı. Cerrahi tedaviyi sonrasında uygun antibiyotik tedavisi
ile semptomları gerileyen ve kontrol görüntüleme yöntemlerinde intraabdominal
patoloji saptanmayan hastada tam klinik iyileşme sağlanamadı. Takibinde
pulmoner semptomlarının artması üzerine bronkoskopi yapılan hastaya alınan
bronş yıkama sıvısında aside dirençli basillerin görülmesiyle pulmuoner
tüberküloz tanısı konuldu. Anti tüberküloz tedavi ile tam klinik iyileşme
sağlanan hasta TP olarak kabul edildi.
Sonuç:
Sıklığı artan TP semptomlarının birçok hastalığı taklit etmesi nedeniyle tanısında
zorluklar ve gecikmeler olmaktadır. Özellikle risk faktörü olan bireylerde TP akılda
tutulmalı ve nadir de olsa postoperatif dönemde akut batına yol açabileceği
düşünülmelidir. Erken teşhis morbidite ve mortaliteyi azaltırken gereksiz
cerrahi müdahaleyi engeller.
Anahtar Kelimeler
Kaynakça
- 1. Duff P. Pathophysiology and management of postcesarean endomyometritis. Obstet Gynecol. 1986 Feb;67(2):269-76.
- 2. Duff P. Diagnosis and Management of Postoperative Infection. Glob libr women's med. 2011, ISSN: 1756-2228; DOI 10.3843/GLOWM.10032.
- 3. Delisle M, Seguin J, Zeilinski D, Moore DL. Paediatric abdominal tuberculosis in developed countries: case series and literature review. Arch Dis Child. 2016;101:253-8.
- 4. Marshall JB. Tuberculosis of gastrointestinal tract and peritoneum. Am J Gastroenterol 1993;88:989-99. 5. Dinler G, Sensoy G, Helek D, Kalayci AG. Tuberculous peritonitis in children: report of nine patients and review of the literature. World J Gastroenterol 2008;21: 7235-7239.
- 6. Forssbohm M, Zwahlen M, Loddenkemper R, Rieder HL. Demographic characteristics of patients with extrapulmonary tuberculosis in Germany. Eur Respir J 2008; 31: 99-105.
- 7. Rowińska-Zakrzewska E. Extrapulmonary tuberculosis, risk factors and incidence. Pneumonol Alergol Pol 2011; 79: 377-378.
- 8. Long S, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases (4th ed). New York: Elsevier Saunders; 2012.
- 9. Cruz AT, Starke JR. Clinical manifestations of tuberculosis in children. Paediatr Respir Rev 2007;8: 107-117.
- 10. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis-presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005;22:685-700.
- 11. Rasheed S, Zinicola R, Watson D, et al. Intra-abdominal and gastrointestinal tuberculosis. Colorectal Disease 2007;9:773-83.
- 12. Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002;12:312-23. 13. Bhargave DK, Shriniwas, Chopra P. Et al. Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol 1992;87:109-12.
- 14. Yancey MK, Clark P, Duff P. The frequency of glove contamination during cesarean delivery. Obstet Gyne¬col 1994;83:538-542.
- 15. Watts DH, Hillier SL, Eschenbach DA. Upper genital tract isolates at delivery as predictors of post-cesar¬ean infections among women receiving antibiotic pro¬phylaxis. Obstet Gynecol 1991;77:287-292.
- 16. Kadanalı A, Karagöz G. Puerperal Infections. Medical Journal of Ümraniye 2012;5;1.
- 17. Uyanıkoğlu H, Uyanıkoğlu A, Büyükfırat E, Gengeç K. Importance of laparoscopic intervention in the differential diagnosis of peritonitis carcinomatosa and tuberculous peritonitis. Turk J Gastroenterol 2017; 28: 528-30.
- 18. Boss JD, Shah CT, Oluwole O, Sheagren JN. TB Mistaken for Ovarian Carcinomatosis Based on an Elevated CA-125. Case Report Med. 2012;2012:215293. Epub 2012 Feb 20.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Nisan 2019 |
| Gönderilme Tarihi | 30 Nisan 2018 |
| Kabul Tarihi | 19 Haziran 2018 |
| Yayımlandığı Sayı | Yıl 2019 |
