Abdominal tuberculosis

Abdominal tuberculosis has no pathognomonic symptoms. Many recognize it is often encountered with various general somatic diseases. Therefore, the majority of patients with abdominal tuberculosis are examined in the general medical network under all possible diagnoses. Most cases of complicated abdominal tuberculosis are the reason for urgent operations in general surgical hospitals, which are subjected to up to 25% of patients.

In recent years, there has been an increase in the number of patients hospitalized with generalized and advanced forms of abdominal tuberculosis, as well as with complications developing after inadequate surgical interventions performed in the general medical network. To date, the time from the initial visit of a patient with abdominal tuberculosis to the medical network to the determination of the correct diagnosis remains unreasonably high.

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Tuberculous peritonitis

Tuberculous peritonitis (tuberculosis of the peritoneum) is mainly considered a manifestation of the period of primary tuberculous infection as a consequence of the lympho-hematogenous spread of the process, or it is a complication of specific damage to the lymph nodes of the abdominal cavity, intestines, genitals, spine, spreading by contact and lymphogenous routes.

Regardless of the genesis, the clinical picture of peritonitis may occupy a dominant position in the general symptomatology of the disease or be concomitant with the main disease in terms of severity (in tuberculous mesadenitis and intestinal lesions, etc.). Particularly severe peritonitis develops when a tuberculous ulcer of the intestine perforates into the abdominal cavity or when caseous lymph nodes of the mesentery break through. During the period of secondary tuberculosis, the spread of the process from the mesenteric nodes, intestines and genitals often leads to the development of a dry form of peritonitis with lesions of limited areas of the peritoneum.

Tuberculous, exudative, exudative-adhesive and caseous-ulcerative forms of tuberculous peritonitis are distinguished. Tuberculous tuberculous peritonitis is characterized by an acute course, beginning with an increase in body temperature, the appearance of chills and abdominal pain. The tongue is dry, with a whitish coating, the anterior abdominal wall is tense, does not participate in breathing: symptoms of peritoneal irritation are clearly visible (symptoms of Voskresensky, Shchetkin-Blumber, Sitkovsky, etc.). The vast majority of patients undergo emergency surgery with a diagnosis of "acute abdomen", etc. In this case, tuberculous rashes are found on the peritoneum.

Exudative tuberculous peritonitis is the outcome of tubercular or allergic reaction to toxins of mycobacterium tuberculosis. It is characterized by the formation of exudate in the abdominal cavity. The disease develops gradually with the appearance of vague abdominal pain, unstable stool, subfebrile body temperature, weakness, dyspeptic disorders. The abdomen increases in volume, sometimes significantly. Symptoms of peritoneal irritation are smoothed out, determining the presence of ascitic fluid.

Adhesive peritonitis is a complicated form of tuberculosis of the abdominal organs with the formation of multiple adhesions. The clinical course is undulating. Patients complain of general weakness, abdominal pain, nausea, and diarrhea. Adhesive intestinal obstruction is a common complication. Exudative-adhesive peritonitis is characterized by the appearance of encapsulated exudate, determined by percussion. The general condition of the patient remains satisfactory for a long time. Caseous-ulcerative peritonitis is characterized by the appearance of foci of caseous necrosis on the parietal and visceral peritoneum with the formation of ulcers of varying sizes. The clinical course of the disease resembles adhesive peritonitis. This is the most severe form of tuberculous peritonitis. Complications in the form of fistulas into the internal organs and out through the abdominal wall are often observed. The general condition of patients is extremely severe, high body temperature is noted.

Tuberculous mesadenitis

The clinical course of tuberculous mesadenitis is characterized by the absence of pathognomonic symptoms. It can be acute and chronic, with remissions and exacerbations. In the acute course, abdominal pain of various localizations is noted, but most often in the navel, left hypochondrium and right iliac region. The pain can be intense and resemble the picture of an acute abdomen. Usually the abdomen is uniformly swollen, not tense, the anterior abdominal wall participates in breathing. Palpation of the abdomen reveals moderate pain to the left of the navel (positive Sternberg symptom), a positive Klein symptom (shifting pain when the patient moves to the left side). Symptoms of peritoneal irritation are not expressed. Enlarged caseous lymph nodes that would be accessible to palpation, especially in adults, are observed as an exception.

Chronic tuberculous mesadenitis occurs in waves, periods of exacerbation are replaced by remissions. The most common symptom is abdominal pain, which corresponds to the localization of the pathological process (along the projection of the mesenteric root). The pain can be dull and aching or colic-like. Patients often complain of abdominal distension, increasing by the end of the day. The pain is often caused by the pressure of calcified lymph nodes on the vascular-nerve bundle of the mesentery. Bedsores may develop.

Other localizations of abdominal tuberculosis

Tuberculosis of the esophagus and stomach is observed relatively rarely. Forms of damage: ulcerative, stenotic and miliary. Patients complain of pain behind the breastbone, dysphagia. Esophagoscopy reveals ulcers, hyperplastic granulation or scarring of ulcers with the development of stenosis.

Gastric tuberculosis manifests itself in the form of ulcerative, hypertrophic (tumor-like), fibrous-sclerotic and mixed forms. In the early period of the disease, dull pain in the epigastric region, belching, nausea, and loss of appetite are noted. Over time, pylorostenoea may develop. The diagnosis is confirmed by X-ray, fibrogastroscopy with histological examination of the biopsy, differential diagnostics are often carried out with gastric tumors.

Liver tuberculosis occurs in three forms: miliary, diffuse, and less commonly focal, such as tuberculoma. In the miliary form, typical tuberculous granulomas form in the liver. Large caseous foci are encapsulated and calcified, and liver abscesses may form. Clinically, the lesion is manifested by jaundice, liver enlargement, and splenomegaly. To diagnose the disease, laparoscopy (laparotomy) is performed with biopsy and histological examination; gallbladder tuberculosis is considered a rare disease.

Tuberculosis of the spleen gives scanty symptoms. Splenomegaly, subfebrile body temperature, and ascites are possible. Calcifications are found in the spleen area.

Tuberculosis of the pancreas is rarely observed, it is usually detected at the section. Typical symptoms are not found. Abdominal tuberculosis proceeds as chronic pancreatitis.