Tuberculous peritonitis is not a rare disease but diagnosis is often missed because of its variable and nonspecific clinical manifestations. Microbiologic or histologic confirmation is necessary for definite diagnosis of tuberculous peritonitis
but
is
not always possible ; therapeutic trials with antituberculous medications may be necessary for some cases. This study was done to evaluate the efficiency of diagnostic modalities for tuberculous peritonitis and to provide the guideline for
therapeutic
trial.
We reviewed the medical records of the 77 tuberculous peritonitis patients. Their clinical manifestations, ascites characteristics, results of microbiologic examinations of peritoneal fluid, peritoneal biopsy findings, and clinical response to
antituberculous medications were analysed.
Of the 77 cases, 28 were male and 49 were female patients. The mean age was 40 years. The most common symptoms were abdominal fullness(79%), fever/chill(64%), abdominal pain(64%) and malaise(61%). Physical examination showed shifting dullness in
79% of
the cases, abdominal tenderness in 54%, rebound tenderness in 25%, and abdominal mass in 10%. Examination of peritoneal fluid revealed lymphocyte-predominant exudate in 78% of the cases. AFB smear and culture of peritoneal fluid were postitive
only
in
2% and 5% of the cases, respectively. Histologic findings of peritoneal biopsy using the peritoneoscope were caseating granuloma(36%), non-caseating granuloma(54%) and nonspecific inflamation(10%). With antituberculous medications. 64% of the
cases
showed clinical improvement within 2 weeks and 85% within 1month.
Peritoneal fluid examination and peritoneoscopic biopsy could provide important clues for diagnosis of tuberculous peritonitis in many cases, but definite microbiologic or histologic diagnosis was possible in only 38% of cases. In clinically
suspected
cases without definite diagnosis, therapeutic trial with antituberculous medications is recommended and close follow-up for at least 1 month should be done to observe the clinical response. (Korean J Gastroenterol 1994 ; 26 : 181-187)
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