Management of wet ascitic type of peritoneal tuberculosis: single center experience

OBJECTIVE: We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic con-firmation of wet ascitic type of peritoneal tuber-culosis (TB).PATIENTS AND METHODS: Between Janu-ary 2008 and March 2019, 17 patients whose as -cites were investigated by a gastroenterologist and who were thought to have non-cirrhotic as -cites were referred to our Surgery clinic for peri-toneal biopsy. The clinical, biochemical, radio-logical, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed ret-rospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eo-sin-stained preparations revealed necrotiz-ing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Eh-rlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopatho-logical findings were also considered.RESULTS: Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdomi-nal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologi-cally, necrotizing granulomatous peritonitis con-sistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen pa-tients, laparotomy was preferred in the remain-ing one due to previous surgical procedures. However, seven were converted to open laparot-omy.CONCLUSIONS: Diagnosis of abdominal TB requires high index of suspicion, and the treat-ment should be prompt to reduce the morbidity and mortality associated with delay in treatment.