Tuberculosis Peritoneum, Mesentry)

8/6/2019 Tuberculosis Peritoneum, Mesentry)

http://slidepdf.com/reader/full/tuberculosis-peritoneum-mesentry 1/17

TUBERCULOSIS (PERITONEUM, MESENTRY)

PRESENTED BY:- ASHARBH RAMAN

ROLL NO. 22



TUBERCULOUS PERITONITIS

TWO TYPES:-

1. ACUTE TUBERCULOUS PERITONITIS.

2. CHRONIC TUBERCULOUS PERITONITIS.







2. CHRONIC TUBERCULOUS PERITONITIS.

The condition presents with:-

A bdominal pain (90% of cases)

Fever (60%)

Loss of weight (60%)

A scites (60%)

Night sweats (37%)

A bdominal mass (26%).



ORIGIN OF INFECTION

Infection originates from:-

Tuberculous mesenteric lymph nodes.

Tuberculosis of ileocaecal region.

A tuberculous pyosalpinx.

Blood-bourne infection from pulmonary tuberculosis,

usually the ¶miliary· but occasionally the ¶cavitating· form.



VARIETIES OF TUBERCULOUS PERITONITIS.

There are four varieties of tuberculous peritonitis :-

A scitic

Encysted

Fibrous

Purulent



ASCITIC FORM

The onset is insidious.

The peritonium is studded with tubercles and the

peritoneal cavity becomes filled with pale, straw colouredfluid.

There is loss of energy, facial pallor and some loss of

weight.

Pain is often absent, there is considerable abdominal

discomfort(associated with constipation or diarrhoea).



On inspection, dilated veins may be seen coursing beneath

the skin of the abdominal wall.

On palpation, a transverse solid mass can often be

detected(this is rolled up greater omentum infiltrated with

tubercles).



ENCYSTED FORM

It is similar to ascitic form except that one part of the

abdominal cavity alone is involved.

A localised intra-abdominal swelling is produced whichgives rise to difficulty in diagnosis.

Late intestinal obstruction is a possible complication.



ENCYSTED FORM



FIBROUS FORM

It is characterised by the production of widespread

adhesions.

This causes coils of the intestine, especially the ileum to

become matted together and distended.

The distended coils act as a blind loop and give rise to

steatorrhoea, wasting and attacks of abdominal pain.

The first intimation of the disease may be subacute or

acute intestinal obstruction.



If the adhesions are accompanied by fibrous strictures of

the ileum as well, it is best to excise the affected bowel.

Small bowel bypass should be avoided to prevent

development of a ¶blind loop· syndrome.

A nti-tuberculous therapy will often rapidly cure the

condition without the need of surgery.



PURULENT FORM

It is a rare form of peritonitis.

Usually it is secondary to tuberculous salpingitis.

Pus is present.

Siezable cold abscess often form and point on the surface,

commonly near the umbilicus, or burst into the bowel.

In addition to prolonged general treatment, operative

treatment may be necessary for the evacuation of cold

abscess.



TUBERCULOSIS OF MESENTERIC LYMPH NODES

This is a rare entity and seen mainly in children.

Tubercle bacilli enter the mesenteric lymph nodes through

Peyer·s patches.



V ARIOUS TYPES OF PRESENTATION OF THE

DISEASE :-

a) A s a cause of abdominal pain.

b) A s a cause of general symptoms.

c) A s a cause of intestinal obstruction.

d) Indistinguishable from appendicitis.

e) A s pseudomesenteric cyst.



THANK YOU

Documents

Tuberculosis Peritoneum, Mesentry)