Search

Objective: To determine the features of diagnosis and clinical course of abdominal tuberculosis in children., Material and Methods: Eighteen children aged from 5 days to 16 years with abdominal tuberculosis have been followed-up throughout 50 years. Diagnostic process implied anamnesis, objective examination, laboratory data and specific samples, ultrasound, X-ray examination, MRI, CT and morphological examination of specimens., Results: Intestinal form was diagnosed in 2 children with abdominal tuberculosis, mesadenitis - 3 patients, liver tuberculosis - 4 ones, tuberculosis of uterine appendages - 3 patients, peritonitis - 6 ones. CT of the abdomen, diaskintest and morphological examination were the most important diagnostic methods. Laparotomy was performed in 16 children. Five cases are decsribed., Conclusion: Abdominal tuberculosis in children is mostly secondary. Several anatomical regions are simultaneously involved in specific process. Isolated lesion of one abdominal organ is rare. Active tuberculosis of respiratory organs in pregnant women has a significant negative impact on the fetus and newborns.

The poly-morbidity is an actual problem of clinical medicine. The chronic hepatitis and tuberculosis are among widespread socially significant diseases while their relationship needs further investigation. The purpose of study is to analyze rate of occurrence, structure and clinic а chronic hepatitis taking course in comorbidity with tuberculosis of various localizations. The technique of continuous sampling was applied to carry out cohort randomized single-staged study analyzing rate structure and clinic of chronic hepatitis in 1189 patients with tuberculosis including pulmonary (n=1125), extra-pulmonary (n=24), abdominal (n-40) localizations. The chronic hepatitis is established in 45% of all cases and in half of cases out of them at the stage of exacerbation (53.2%) when the disease is presented by viral (59.6%) predominantly hepatitis C, alcoholic (25.7%), non-alcoholic (9.8%) and medicinal (4.9%) steatohepatits. The chronic hepatitis associates with pulmonary tuberculosis 3.4-1.7 times more often than with extra-pulmonary and abdominal tuberculosis. The chronic hepatitis is characterized by minimal and moderate activity of inflammation. The chronic hepatitis in case of abdominal tuberculosis manifests more expressed alterations of all laboratory syndromes of hepatitis. The medicinal hepatitis was established only in case of pulmonary tuberculosis. The chronic hepatitis С and B progresses in a comorbide way, is characterized by little symptoms, cytolysis with 2.3-2.8 standards of ALT, AST, minimal parenchymatous jaundice and cholestasis with activity of GGTP 2.86 of standards, mesenchymal inflammation in 3.1-3.4 times more often in case of its comorbidity with extra-pulmonary and abdominal tuberculosis. The alcoholic steatohepatitis is characterized by higher cytolysis, predominance of activity of AST over ALT, more expressed parenchymatous jaundice and cholestasis. The non-alcoholic steatohepatitis is characterized by poly-morbidity with diabetes mellitus type II also, cardiovascular pathology, steatosis of liver, the lowest parameters of markers of cytolysis, mesenchymal inflammation, jaundice, cholestasis and normal values of markers of hepatic cellular inadequacy. The medicinal hepatitis is characterized by increasing of asthenia, nausea, development of jaundice, skin itching, hepatomegaly,cytolysis, cholestasis, hyper-bilirubinemia against the background of specific poly-chemotherapy., Competing Interests: The authors declare no conflict of interest.

The results of treatment of 81 patients, suffering tuberculosis and operated in emergency for an acute surgical diseases of the abdominal cavity organs, are adduced, in 29 of them--nonspecific diseases of nontuberculosis genesis were diagnosed. In 52 patients the indication for emergency operation performance were complications of abdominal tuberculosis (perforation of the tuberculosis ulcers of small intestine--in 37, the tuberculosis mesadenitis--in 15), of them in 34--pulmonary tuberculosis was in inactive phase, that's why the HIV presence was supposed. In 26 patients the diagnosis was confirmed, basing on serologic analysis data. The presence of intraabdominal catastrophe, caused by abdominal tuberculosis complications on inactive pulmonary tuberculosis background witnesses with 85.3% probability the HIV-infectioning of the patient.

Results of surgical treatment of 31 patients with complicated forms of abdominal tuberculosis treated in 2001-2003 were analyzed. Before 2003 surgery was mainly palliative and managed by suturing of perforated ulcers or economic resection of the small intestine (group 1--17 patients) was made. Since 2003 radical right-sided hemi-colectomies with removal of caseous mesenterial lymph nodes is used (group 2--14 patients). Peritoneal lavage with antituberculosis drugs was performed after surgery. From 17 patients of group 1--12 died, from 14 patients of group 2--5. It is concluded that radical surgery in complicated forms of abdominal tuberculosis permits to improve results of surgical treatment of this disease.

The results of surgical treatment were analyzed in 31 patients with complicated abdominal tuberculosis in 2001 to 2003. Before 2003, a surgical intervention was mainly palliative and reduced to the suturing of perforative tuberculous ulcers limited to the resections of the small intestine and to the separation of adhesions (Group 1, n=17). Then radical surgical interventions were undertaken in the volume of extended right-sided hemicolectomies, by removing caseously changed mesenteric lymph nodes (Group 2, n=14). Postoperative peritoneal lavage was performed, by using antituberculous agents. Twelve and 5 patients died in Groups 1 and 2, respectively. The authors suggest that radical surgical interventions for complicated abdominal tuberculosis can improve the outcomes of treatment of this disease.

For 5 years the authors observed isolated abdominal tuberculosis in 6 patients. Five of them who were urgently operated upon had perforations of the tuberculous ulcers of the intestine. A specific character of the inflammation was confirmed by histological investigations. Four patients are described in detail. One of them had six perforated tuberculous ulcers of the jejunum. All these patients died. Recommendations are given how to improve the diagnosis of abdominal tuberculosis and treat patients with this severe disease.

Primary tuberculosis of the intestines was revealed in four patients. The process was localized in the cecum in three and in the descending colon in one patient. The true diagnosis was suspected before the operation in one patient, determined during the operation in two patients and after pathohistological study in one patient. The course of the disease was complicated by intestinal obstruction in three cases by anemia in one case. The differential diagnosis was made with intestinal tumors. Three patients underwent right hemicolectomy and one patient left hemicolectomy. Specific therapy was prescribed after recognition of the tuberculous process. All patients recovered.

The article deals with the difficulties of establishing the diagnosis of abdominal tuberculosis. Seven patients were under observation. In 5 the diagnosis was made histologically after operative intervention. In 6 patients abdominal tuberculosis was combined with a specific process in the lungs. Two cases of tuberculosis of the stomach, intestine, and mesenteric lymph nodes following a course resembling that of an abdominal "tumor" are described. For the exclusion of tuberculosis it is recommended that fluorographic examination of the lungs should be included in the complex preoperative management of patients.

In the paper, data on 502 patients with abdominal tuberculosis are reported, including 21--with perforative peritonitis due to the perforation of tuberculous intestinal ulcers. In its manifestations perforative peritonitis may show a latent or "an acute abdomen" course. Among 12 operated patients there were 5 lethal issues. Such high postoperative mortality is accounted for late terms of establishing the correct diagnosis and admission of patients in a poor and hopeless condition.