Clinical challenge for physicians - abdominal tuberculosis: review of 24 cases

Yıl 2012, Cilt: 20 Sayı: 3, 72 - 76, 01.12.2012

Meltem Ergün Bilge Tunç Aysel Ülker Nurgül Şaşmaz

https://doi.org/10.17940/endoskopi.74820

Öz

Background and Aims:Abdominal tuberculosis is still seen in immunocom-petent adults in developing countries. The accurate diagnosis of abdominal tuberculosis requires a high index of suspicion and combination of diagnos-tic modalities in clinic practice and is time-consuming. Materials and Met-hods: The records of 24 patients (10 females, mean age: 40 years, range: 21-68 years) diagnosed with abdominal tuberculosis between January 2000 and December 2011 were analyzed retrospectively. Patients' characteristics, labo-ratory investigations, and radiological, endoscopic and surgical findings we-re evaluated. Follow-up information was obtained by telephone contact and scheduled visits. Results: 24 patients were enrolled in the study. The most frequent symptoms were abdominal pain (n=19, 79%), fever (n=20, 83%), ascites (n=8, 33%), diarrhea (n=10, 42%), and weight loss (n=16, 66%). Su-bacute/acute intestinal obstruction was found in 5 cases. Past history of treat-ment for tuberculosis and family history of tuberculosis were present in 4 (16%) and 5 (21%) patients, respectively. The basis of diagnosis of abdomi-nal tuberculosis were histopathology obtained by endoscopic/colonoscopic biopsies in 8 (33%), ultrasound/computed tomography-guided biopsies in 5 (21%), laparoscopic/surgical interventions in 7 (29%), and ascites examinati-ons in 2 (8%) patients. Microbiological tests were positive in only 4 (17%) patients. The predominant site of involvement by abdominal tuberculosis was intestinal in 12 (50%), peritoneal in 8 (33%), and solid viscera/nodal in 4 (16%) cases. Conclusions: Abdominal tuberculosis is a complex disease with non-specific symptomatology. Combination of a high index of clinical suspi-cion and use of multiple adjuvant diagnostic tools is required to make the correct diagnosis.

Anahtar Kelimeler

Gastrointestinal tuberculosis, abdominal tuberculosis, intestinal tuberculosis

Doktorlar için bir klinik zorluk: Abdominal tüberküloz 24 olgunun derlemesi

Öz

Amaç:Abdominal tüberküloz halen gelişmekte olan ülkelerde immun yetmezliği olmayan bireylerde görülebilen bir hastalıktır. Kesin tanı öncelikle bu hastalıktan şüphelenilerek ve farklı tanı metotlarını bir arada kullanarak mümkündür ve uzun zaman alabilir. Gereç ve Yöntem: Ocak 2000 ile Aralık 2011 tarihleri arasında kliniğimizde abdominal tüberküloz tanısı konulan 24 hastanın kayıtları retrospektif olarak analiz edildi. Demografik özellikler, laboratuar kayıtları, radyolojik, endoskopik ve cerrahi bulgular değerlendirildi. Takipler hastalara randevu verilerek veya telefonla yapılan görüşmelerle sağlandı. Bulgular: Toplam 24 hasta çalışmaya dahil edildi (10 bayan, ortalama yaş: 40, dağılım: 2168). Hastaların en sık klinik semptomu ateş (20, %83), karın ağrısı (19, %79), iştahsızlık (17, % 71), kilo kaybı (16,%66), gece terlemesi (12,%50), ishal (10,%42), asit (8, %33) olarak saptandı. Subakut/akut intestinal obstrüksiyon olguların 5'inde (%21) saptandı. Hastaların 4'ünde (%16) geçirilmiş pulmoner tüberküloz hikâyesi, 5'inde (%21) ailede tüberküloz hikâyesi mevcuttu. Hastaların 12'sinde (%50) intestinal tutulum saptanırken, 8'inde (%30) peritoneal ve 4'ünde nodal tutulum saptandı. ‹ntestinal tutulum gösteren hastaların 9'unda (%75) ileoçekal bölgede lezyon saptandı. Abdominal tüberküloz tanısı 8 (33%) hastada endoskopik/ kolonoskopik biopsilerin histopatolojik incelemesiyle, 5 (21%) hastada abdominal ultrason/tomografi rehberliğinde yapılan biyopsilerle, 7 (29%) hastada laparoskopik/cerrahi girişimle, 2 (8%) hastada da asit incelemeleri ile kondu. Mikrobiolojik incelemelerde pozitişik sadece 4 (17%) hastada saptandı. Sonuç: Abdominal tüberküloz spesifik olmayan semptomatolojisi ile karmaşık bir hastalıktır. Tanısını koymak için öncelikle şüphelenmek ve bir çok tanı metotlarını bir arada kullanmak gerekir.

Anahtar Kelimeler

Gastrointestinal tüberküloz, abdominal tüberküloz, intestinal tüberküloz

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