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AIM:To analyze the experience within our hospital and toreview the literature so as to establish the best means ofdiagnosis of abdominal tuberculosis.METHODS:The records of 11 patients (4 males,7 females,mean age 39 years,range 18-65 years) diagnosed withabdominal tuberculosis in Harran University Hospitalbetween January 1996 and October 2003 were analyzedretrospectively and the literature was reviewed.RESULTS:Ascites was present in all cases.Other commonfindings were weight loss (81%),weakness (81%),abdominalmass (72%),abdominal pain (72%),abdominal distension(63%),anorexia (45%) and night sweat (36%).The averagehemoglobin was 8.2 g/dL and the average FAR was 50 mm/h(range 30-125).Elevated levels of cancer antigen CA-125were determined in four patients.Abdominal ultrasoundshowed abnormalities in all cases:ascites in all,tuboovarianmass in five,omental thickening in 3,and enlarged lymphnodes (mesenteric,para-aortic) in 2.CT scans showed ascitesin all,pelvic mass in 5,retroperitoneal lymphadenopathyin 4,mesenteric stranding in 4,omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathyin 2.Only one patient had a chest radiograph suggestive ofa new TB lesion.Two had a positive family history ofpulmonary TB.None had acid-fast bacilli (AFB) in the sputumand the tuberculin test was positive in only two.Laparotomywas performed in 6 cases,laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2.In those patientssubjected to operation,the findings were multiple diffuseinvolvement of the visceral and parietal peritoneum,white‘miliary nodules’or plaques,enlarged lymph nodes,ascites,‘violin string’fibrinous strands,and omental thickening.Biopsy specimens showed granulomas,while ascitic fluidshowed numerous lymphocytes.Both were negative foracid-fast bacilli by staining.PCR of ascitic fluid was positivefor Mycobactenum tuberculosis ( M.tuberculosis) in all cases.CONCLUSION:Abdominal TB should be considered in allcases with ascites.Our experience suggests that PCR ofascitic fluid obtained by ultrasound-guided fine needleaspiration is a reliable method for its diagnosis and shouldat least be attempted before surgical intervention.
AIM: To analyze the experience within our hospital and toreview the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS: The records of 11 patients (4 males, 7 females, mean age 39 years, range 18-65 years) diagnosed withabdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 was analyzedretrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases.Other commonfindings were weight loss (81%), weakness (81%), abdominalmass (72%) The average hemoglobin was 8.2 g / dL and the average FAR was 50 mm / h (range 30-125). The average hemoglobin was 8.2 g / dL and the average FAR was 50 mm / h (range 30-125) . Elevated levels of cancer antigen CA-125were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymphnodes (mesenteric, para-aortic) in 2. CT scans showed ascitesin all, pelvic mass in 5, retroperitoneal ly mphadenopathyin 4, mesenteric stranding in 4, omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathyin 2. One patient had a chest radiograph suggestive ofa new TB lesion.Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum of the tuberculin test was positive in only two. Laparotomywas performed in 6 cases, laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2.In those patientssubjected to operation, the findings were multiple diffuseinvolvement of the visceral and Parietal peritoneum, white’miliary nodules’or plaques, enlarged lymph nodes, ascites, ’violin string’fibrinous strands, and omental thickening. Biopsy specimens showed granulomas, while ascitic fluidshowed numerous lymphocytes. Both were negative foracid-fast bacilli by staining. PCR of ascitic fluid was positivefor Mycobacterium tuberculosis (M. tuberculosis) in all cases. CONCLUSION: Abdominal TB should be considered in allcases with ascites. Our ex perience suggests that PCR ofascicular fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and shouldat least be attempted before surgical intervention.