CONTRIBUTION OF ULTRASONOGRAPHY TO THE DI AGNOSIS OF TUBERCULOUS PERITONITIS - A PROSPECTIVE-STUDY OF 177 CASES

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.