TUBERCULOSIS

(PERITONEUM, MESENTRY)

PRESENTED BY:-
ASHARBH RAMAN
ROLL NO. 22
TUBERCULOUS PERITONITIS

TWO TYPES:-

1. ACUTE TUBERCULOUS PERITONITIS.

2. CHRONIC TUBERCULOUS PERITONITIS.

1. ACUTE TUBERCULOUS
PERITONITIS.
 Tuberculous peritonitis sometimes has an onset that closely
resembles acute peritonitis.

 Straw coloured fluid escapes and tubercles are seen scattered over
the peritoneum and greater omentum.

 Early tubercles are greyish and translucent.

o They soon undergo caseation and appear white or yellow and are
then less difficult to distinguish from carcinoma.

o Occasionally they appear like patchy fat necrosis.

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2. CHRONIC TUBERCULOUS
PERITONITIS.
The condition presents with:-

 Abdominal pain (90% of cases)

 Fever (60%)
 Loss of weight (60%)
 Ascites (60%)
 Night sweats (37%)
 Abdominal mass (26%).
ORIGIN OF INFECTION
Infection originates from:-

 Tuberculous mesenteric lymph nodes.

 Tuberculosis of ileocaecal region.
 A tuberculous pyosalpinx.
 Blood-bourne infection from pulmonary tuberculosis, usually the
‘miliary’ but occasionally the ‘cavitating’ form.
 VARIETIES OF TUBERCULOUS
PERITONITIS.
There are four varieties of tuberculous peritonitis :-

 Ascitic
 Encysted
 Fibrous
 Purulent
ASCITIC FORM
 The onset is insidious.

 The peritonium is studded with tubercles and the peritoneal cavity

becomes filled with pale, straw coloured fluid.

 There is loss of energy, facial pallor and some loss of weight.

 Pain is often absent, there is considerable abdominal

discomfort(associated with constipation or diarrhoea).
 On inspection, dilated veins may be seen coursing beneath the skin
of the abdominal wall.

 On palpation, a transverse solid mass can often be detected(this is

rolled up greater omentum infiltrated with tubercles).
ENCYSTED FORM
 It is similar to ascitic form except that one part of the abdominal
cavity alone is involved.

 A localised intra-abdominal swelling is produced which gives rise to

difficulty in diagnosis.

 Late intestinal obstruction is a possible complication.

ENCYSTED FORM
FIBROUS FORM
 It is characterised by the production of widespread adhesions.

 This causes coils of the intestine, especially the ileum to become

matted together and distended.

 The distended coils act as a blind loop and give rise to steatorrhoea,
wasting and attacks of abdominal pain.

 The first intimation of the disease may be subacute or acute

intestinal obstruction.
 If the adhesions are accompanied by fibrous strictures of the ileum
as well, it is best to excise the affected bowel.

 Small bowel bypass should be avoided to prevent development of a

‘blind loop’ syndrome.

 Anti-tuberculous therapy will often rapidly cure the condition

without the need of surgery.
PURULENT FORM
 It is a rare form of peritonitis.

 Usually it is secondary to tuberculous salpingitis.

 Pus is present.

 Siezable cold abscess often form and point on the surface,

commonly near the umbilicus, or burst into the bowel.

 In addition to prolonged general treatment, operative treatment may

be necessary for the evacuation of cold abscess.
TUBERCULOSIS OF MESENTERIC
LYMPH NODES

 This is a rare entity and seen mainly in children.

 Tubercle bacilli enter the mesenteric lymph nodes through Peyer’s

patches.
VARIOUS TYPES OF PRESENTATION OF THE DISEASE :-

a) As a cause of abdominal pain.

b) As a cause of general symptoms.

c) As a cause of intestinal obstruction.

d) Indistinguishable from appendicitis.

e) As pseudomesenteric cyst.
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