Zusammenfassung
Die Peritonealtuberkulose kann wegen der unspezifischen Symptome sogar für einen erfahrenen Arzt eine diagnostische Herausforderung sein. Wir berichten über zwei Patientinnen, die wegen therapierefraktärer, chronischer Unterbauchmerzen mit Gewichtsabnahme und Ascites in unsere Klinik aufgenommen wurden. Die im Rahmen einer explorativen Laparotomie bei Verdacht auf Peritonealkarzinose entnommenen PEs von der Beckenwand und Omentum majus ergab bei der histopathologischen Untersuchung eine Peritonealtuberkulose. Beide Patientinnen wurden nach der Diagnosestellung tuberkulostatisch mit Isoniazid, Rifampicin, Pyrazinamid und Streptomycin behandelt und sind seitdem beschwerdefrei. Anhand dieser zwei Fallberichte werden die Symptomatik, die Schwierigkeiten bei der Diagnosestellung und die Therapie der Peritonealtuberkulose diskutiert.
Chronic abdominal pains caused by peritoneal tuberculosis - two case reports
Summary
The diagnosis of a peritoneal tuberculosis could be a demanding task for even an experienced Physician, because of the unspecific symptoms. We report on two patients, who as a result of therapy refractory chronic abdominal pains, weight loss and ascites were admitted to our hospital. The excisional biopsy taken from the peritoneum and the omentum major during an exploratory laparotomy resulted in the histopathologic diagnosis of peritoneal tuberculosis being made. Both patients were given tuberculostatic therapy with isoniazid, rifampicin, pyracinamide and streptomycin and both have since recovered. The symptoms, the difficulties encountered in making the diagnosis and the therapy of the peritonealtuberculosis are discussed using these two case reports.
Schlüsselwörter
Unterbauchschmerzen - Peritonealtuberkulose - explorative Laparotomie
Key words
Abdominal pains - peritoneal tuberculosis - explorative laparotomy
Literatur
-
1
Bhansali S K.
Abdominal tuberculosis. Experience with 300 cases.
Am Gasterolenterol.
1977;
67
322-327
-
2 Tuberculosis morbidity-US, 1991. MMWR 1992; 41: 240
-
3
Schieffelheim CW J r, Snider DE J r.
Tuberculosis among homeless populations.
JAMA.
1988;
148
1843
-
4
Braun M M, Byers R H, Heyward W L. et al .
Aquired immunodeficiency syndrome and extra-pulmonary tuberculosis in United States.
Arch Intern Med.
1990;
150
1913-1916
-
5
Aguado J M, Pons F, Casafont F, Miguel G S, Valle R.
Tuberculous peritonitis: a study comparing cirrhotic and noncirrhotic patients.
J Clin Gastroenterology.
1990;
12
530-554
-
6
Reddy K R, Di Prima R E, Roslun J B, Jeffers L J. et al .
Tuberculous peritonitis: Laparoscopic diagnosis of an common disease in the United States.
Gastrointestinal Endoscopy.
1988;
34
422-426
-
7
O’Riordan D K, Deery A, Dorman A, Epstein O E.
Increased CA 125 Antigen A patient with tuberculous peritonitis: case report and review of published books.
Gut.
1995;
36
303-305
-
8
Akinoglu A, Bilgin I.
Tuberculous enteritis and peritonitis.
Can J Surgery.
1988;
31
55-58
-
9
Jorge A D.
Peritoneal tuberculosis.
Endoscopy.
1984;
16
10-12
-
10
Panoskaltsis T A, Moore D A, Haidopoulos, McIndoe A G.
Tuberculous peritonitis: part of the differential diagnosis in ovarian cancer.
American J Obstetrics and Gynaecology.
2000;
182
740-742
-
11
Kao C Y, Liaw C C, Chen T C.
Tuberculosis presenting with pelvic mass, peritoneal lesions and elevation of serum CA 125 mimicking malignant tumor: a case report.
Chang Keng Institute Hsueh Tsa Chih.
2000;
23
230-234
-
12
Geisler J P, Crook D E, Geiler H E, Cudahay T J. et al .
The great imitator: miliary peritoneal tuberculosis mimicking stage III ovarian carcinoma.
European J Gynaecologic Oncology.
2000;
21
115-116
-
13
Straugh J M, Robertson M W, Partridge E E.
A patient presenting with a pelvic mass, elevated CA 125, and fever.
Gynaecologic Oncology.
2000;
77
471-472
-
14
Singh M M, Bhargava A N, Jain K P.
Tuberculous peritonitis. An evaluation of pathogenetic mechanisms, diagnostic procedures and therapeutic measures.
N Engl J Med.
1969;
281
1091-1094
-
15
Marshall J B.
Tuberculosis of gastrointestinal tract and peritoneum.
American J Gastroenterology.
1993;
88
989-999
-
16
Frieden T R, Sterling T, Pablos-Mendez A. et al .
The emergence of drug-resistant tuberculosis in New York City.
N Engl J Med.
1993;
328
521-526
-
17
Denath F M.
Abdominal tuberculosis in children: CT findings.
Gastrointest Radiol.
1990;
15
303-306
-
18
Khoury G A, Payne C R, Harvey D R.
Tuberculosis of peritoneal cavity.
Br J Surg.
1978;
65
808-811
-
19
Kiu M C, Hsueh S, Ng S H, Chen J S.
Elevated serum CA-125 in tuberculosis peritonitis: report of a case.
J Formos Med Assoc.
1994;
93
810-818
-
20
Bergmann J F, Bidart J M, George M, Beaugrand M, Levy V G, Bohoun C.
Elevation of CA 125 in patients with benign and malignant ascites.
Cancer.
1987;
59
213-214
OA Dr. B. Sc. (GH) Philip Boabang
Maria-Hilf-Krankenhaus
Klosterstr. 2
D-50126 Bergheim
Phone: +49-22 71-87-4 51
Fax: +49-22 71-87-4 68
Email: amo-takyi@pat.rwth-aachen.de
