Tuberculous Peritonitis

Tuberculous peritonitis is a chronic diffuse peritoneal infection caused by tubercle bacilli, common in children and young adults, female:male ~1.2-2.0:1. Main features are fatigue, fever, abdominal pain, and distension; classified as adhesive, exudative, or caseous, with complications including obstruction, perforation, and fistulas.

Common Symptoms

Dull pain; station doctor; intestinal adhesion; borborygmus; abdominal doughy sign; diarrhea; ascites; acute abdominal pain; peritonitis

Causes and Pathogenesis

Mostly secondary to other TB. Routes are direct spread from intra-abdominal foci (intestinal, mesenteric lymph node, tubal TB) or hematogenous spread; female predominance may relate to retrograde pelvic infection. (1) Etiology: Bacilli are aerobic acid-fast slender curved rods 1-5 µm × 0.2-0.5 µm, dividing every 18-24 h; lipids are ~1/4 of weight. They resist drying, acid, and alkali; survive 20-30 h in sputum and 6-8 months in damp shade, but are killed by boiling 5 min or direct sun 2 h; UV is effective. Human and bovine types are obligate parasites with equal pathogenicity to humans, monkeys, and guinea pigs. Drug resistance arises naturally or from monotherapy; streptomycin dependence is rare. Peritoneal sources: 1. Direct spread from active intestinal/mesenteric/pelvic foci. 2. Hematogenous spread from miliary/pulmonary TB. (2) Pathogenesis: By main pathology: 1. Exudative: straw-colored serofibrinous exudate, thickened congested peritoneum, yellow/gray miliary tubercles that may coalesce. 2. Adhesive: marked thickening with dense fibrous adhesions forming masses causing chronic obstruction; omentum thickens into a hard cake; severe cases completely obliterate the cavity. 3. Caseous: caseous necrosis with loculated compartments containing turbid purulent fluid, forming internal/fecal fistulas; caseous mesenteric nodes form tuberculous abscesses. Adhesive is most common, then exudative, then caseous; mixed types are common.

Treatment

Drug therapy, rehabilitation

Preventive Measures

1. Control sources: periodic mass lung exams and registration. 2. Cut transmission: manage sputum; public health campaigns; do not spit; burn sputum on paper or use 2% cresol/1% formalin; expose contaminated items to sun. 3. BCG vaccination enhances resistance; China vaccinates at birth, with catch-up for Mantoux-negative individuals; ethnic minorities, border residents, and recruits require Mantoux testing before vaccination.

Department to Visit

It is recommended to visit the Gastroenterology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.