F. Fadli et al., CONTRIBUTION OF ULTRASONOGRAPHY TO THE DI AGNOSIS OF TUBERCULOUS PERITONITIS - A PROSPECTIVE-STUDY OF 177 CASES, Annales de Gastroenterologie et d'Hepatologie, 34(1), 1998, pp. 44-48
Tuberculous peritonitis remains common in developing countries. The di
agnosis rests on histologic studies of specimens collected during lapa
roscopy. However, ultrasonography is being increasingly used as the fi
rst-line investigation and is proving to be very helpful for the diagn
osis and follow-up of tuberculous peritonitis. A study was conducted t
o define the ultrasonography findings in tuberculous peritonitis, to d
etermine which combinations of ultrasonography features are most sugge
stive of this diagnosis, and to compare ultrasonography and laparoscop
y findings. Ultrasonography was performed prospectively in 185 patient
s admitted between January 1991 and December 1996 for symptoms consist
ent with tuberculous peritonitis. This diagnosis was confirmed by ultr
asonography in 177 cases (95%). Features included peritoneal thickenin
g with adhesions in 100% of cases, granulomas in 94 % of cases, bowel
loops matted around a thickened mesentery in 30% of cases, and subclin
ical ascites in 5% of cases. Concomitant presence oi thickening of the
peritoneum with granulomas and adhesions may indicate a high suspicio
n oi tuberculous peritonitis. Based on ultrasonography findings, we cl
assified our patients as having ascitic tuberculosis (n = 80), fibroad
hesive tuberculosis(n = 70), ulcerating and caseous tuberculosis (n =
24), or sheathing tuberculosis (n = 2). In every case the diagnosis wa
s confirmed histologically. Specimens were obtained during laparoscopy
or, in fibroadhesive or pseudosurgical forms, during minilaparotomy.
In three patients, follow-up ultrasonograms disclosed persistence or w
orsening of the lesions denoting resistance to the antituberculous age
nts used. Comparisons of ultrasonography with laparoscopy or minilapar
otomy findings in the patients and in a control group showed that the
sensitivity and specificity of ultrasonography for the diagnosis of tu
berculosis were 90% and 96%, respectively, with even higher specificit
y rates being achieved in patients with suggestive combinations of ult
rasonographic findings.