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DOI: 10.1055/s-0031-1283772
© Georg Thieme Verlag KG Stuttgart ˙ New York
Laparoskopie in der gastroenterologischen Diagnostik: Peritoneale miliare Tuberkulosemanifestationen als wichtige Differenzialdiagnose unklaren Fiebers
Laparoscopy as Gastroenterological Investigation: Peritoneal Miliary Tuberculosis – An Important Differential Diagnosis in Patients with Fever of Unknown OriginPublication History
Publication Date:
21 December 2011 (online)
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Zusammenfassung
Ein aus Indien stammender 32-jähriger Patient stellte sich in der Notaufnahme zur Abklärung von Fieberschüben, unspezifischen abdominellen Beschwerden und eines erheblichen Gewichtsverlustes vor. Eine umfangreiche bakteriologische und serologische Diagnostik blieb ohne wegweisenden Befund. Im Rahmen der Bildgebung fielen sonografisch abdominelle Lymphome sowie Aszites auf. In der CT wurde ein tuberkulöser Primärkomplex sowie verkalkte Lymphknoten im Sinne einer abgelaufenen Lungentuberkulose detektiert. Zur differenzialdiagnostischen Abklärung erfolgte eine Laparoskopie, die eine diffuse peritoneale Aussaat sowie Adhäsionen zeigte und damit die Verdachtsdiagnose einer Abdominaltuberkulose eindrucksvoll bestätigte. Die Laparoskopie sollte bei Patienten mit Aszites unklarer Genese oder Verdacht auf abdominelle Tuberkulosemanifestationen Bestandteil der Diagnostik sein.
Abstract
A 32-year-old patient of Indian origin presented to our hospital with unexplained continued fever, non-specific abdominal pain and a remarkable loss of weight. Extensive diagnostics including bacterial and serologic investigations didn‘t reveal significant findings. Imaging investigations showed enlarged abdominal lymph nodes and ascites on ultrasound. On CT-scan a tuberculous primary complex and calcified lymph nodes as a sign of preceding lung tuberculosis were detected. Laparoscopy was performed for further differentiation showing spreaded peritoneal nodules and adhesions. The macroscopic appearance impressingly confirmed the diagnosis of abdominal tuberculosis manifestations. We conclude that laparoscopy should be performed in patients with ascites of unknown origin or suspected abdominal tuberculosis.
Schlüsselwörter
Laparoskopie - Miliartuberkulose - Lymphadenopathie - unklares Fieber
Key words
laparoscopy - miliary tuberculosis - lymphadenopathy - fever of unknown origin
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Dr. J. Binkau
Sana Klinikum Lichtenberg · Oskar-Ziethen-Krankenhaus
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Email: J.Binkau@sana-kl.de