See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/324043261

Peritoneal tuberculosis: Advances and controversies

Article · March 2018

DOI: 10.4103/LJMS.LJMS_35_17

CITATIONS READS
9 452

1 author:

Fahmi Khan
Hamad Medical Corporation
144 PUBLICATIONS   1,548 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

liver abscess View project

dyspepsia View project

All content following this page was uploaded by Fahmi Khan on 27 March 2018.

The user has requested enhancement of the downloaded file.

[Downloaded free from http://www.ljmsonline.com on Tuesday, March 27, 2018, IP: 49.207.54.199]

Review Article

Peritoneal Tuberculosis: Advances and Controversies

Fahmi Yousef Ahmed Khan
Department of Medicine, Hamad General Hospital, Doha, Qatar

Abstract
Peritoneal tuberculosis (TB) remains a public health problem especially in the developing countries, even in the developed countries, where
the disease had been mostly controlled; it poses a new challenge for health‑care facilities as a result of increased immigration from high
prevalence area, the use of more potent immunosuppressive therapy and the acquired immunodeficiency syndrome epidemic. The diagnosis of
peritoneal TB is often challenging and cannot be made or excluded on the basis of clinical findings, which are quite protean and nonspecific.
Blood biochemistry, complete blood cell count, and radiographic studies are of limited diagnostic value. Acid‑fast smear of ascitic fluid has a
low yield and cultures require weeks to give results and are positive in 2%–50% of diagnosed cases. Polymerase chain reaction analysis for
rapid detection of bacillus tubercles in ascitic fluid has low yield, and the role of other biomarkers such as adenosine deaminase and gamma
interferon is less well described and currently being evaluated as diagnostic tools. Laparoscopy with directed biopsy provides a rapid and
correct diagnosis in 76%–100% of cases and should be performed early in suspected cases. Six‑month therapy with the 4‑drug regimen is
effective in most of the patients, while the role of adjunctive corticosteroid therapy remains controversial.

Keywords: Ascites, laparoscopy, peritoneal biopsy, tuberculous peritonitis

Introduction with socioeconomic factors such as poverty, malnutrition,

deprivation, overcrowding, illiteracy and limited access to
Tuberculosis (TB) remains a major worldwide problem with
health‑care facilities, having a high prevalence in developing
significant morbidity and mortality. It ranks as the tenth countries.[3] In developed countries, where the disease had
leading cause of death worldwide.[1] TB is primarily a disease been mostly controlled; TB poses a new challenge for
of the lungs, but it can affect almost any organ in the body. health‑care facilities. Increased immigration from high
Extrapulmonary TB refers to TB involving organs other than prevalence area, the use of more potent immunosuppressive
the lungs (e.g., pleura, lymph nodes, abdomen, genitourinary therapy and the acquired immunodeficiency syndrome
tract, skin, joints and bones, or meninges).[2] Peritoneal TB is epidemic has contributed to the resurgence of the disease in
a variant of abdominal TB; it poses a public health problem areas where it had been considered under control.[3‑5] Several
in endemic regions of the world. The aim of this review is to risk factors for peritoneal TB have been identified. Liver
describe the epidemiology, pathogenesis, clinical and futures cirrhosis Especially alcoholic (esp. alcoholic), chronic renal
of the peritoneal TB and to review recent development in the failure, chronic ambulatory peritoneal dialysis, underlying
methods of diagnosis and treatment. malignancy, treatment with anti‑tumor necrosis factor agents,
intravesical treatment with Bacillus Calmette‑Guérin, diabetes
Epidemiology mellitus, immunosuppression with prolonged steroid therapy
or chemotherapeutic agents and HIV infection.[6‑11]
TB is a worldwide disease. In 2015, there were an
estimated 10.4 million new TB cases worldwide, of which Globally, there is continuous fall in the number of TB deaths,
5.9 million  (56%) were men and 3.5 million  (34%) were however, there were an estimated 1.4 million TB deaths in
women. Children accounted for 1.0 million (10%), and people
living with HIV accounted for 1.2 million (11%) of all new Address for correspondence: Dr. Fahmi Yousef Ahmed Khan,
TB cases. Moreover, there were an estimated 480,000 new Department of Medicine, Hamad General Hospital, Doha, Qatar.
E‑mail: [email protected]
cases of multidrug‑resistant TB.[1] TB has strong associations

Access this article online This is an open access article distributed under the terms of the Creative Commons
Quick Response Code: Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
Website: and build upon the work non-commercially, as long as the author is credited and the new
www.ljmsonline.com creations are licensed under the identical terms.

For reprints contact: [email protected]

DOI:
10.4103/LJMS.LJMS_35_17 How to cite this article: Ahmed Khan FY. Peritoneal tuberculosis: Advances
and controversies. Libyan J Med Sci 2018;2:3-7.

© 2018 Libyan Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 3

[Downloaded free from http://www.ljmsonline.com on Tuesday, March 27, 2018, IP: 49.207.54.199]

Khan: Peritoneal tuberculosis: Advances and controversies

2015, and an additional 0.4 million deaths resulting from TB conditions; therefore, it is necessary to maintain a high index
disease among people living with HIV.[1] of clinical suspicion to avoid the morbidity and mortality
associated with delayed diagnosis. In general, the onset is
Peritoneal TB accounts for about 0.1%–0.7% of all cases of TB
quite insidious, with symptoms usually persisting for weeks
representing 4%–10% of extra‑pulmonary TB and 25%–60% of
to months before the patients sought medical help, and a
abdominal TB cases.[12‑14] Although peritoneal TB can develop
diagnosis of peritoneal TB was made.[14,19‑23] Abdominal pain
at any age, peritoneal TB is seen more commonly between 25
and swelling are the common presenting symptoms in many
and 55 years of age. The gender difference among patients with
studies.[14‑23] Other symptoms include fever, night sweats, and
peritoneal TB varies from study to study and from country to
weight loss. Ascites, abdominal tenderness, and hepatomegaly
another. In general, in developing countries,[15‑19] the disease
may be noted on physical examination.[14‑23]
is observed predominantly in females, while in industrialized
and some rich countries, there is male predominance which
may be attributed to the presence of male immigrants in the Diagnosis
workforce.[14,20‑23] The diagnosis of peritoneal TB is often challenging and cannot
be made or excluded on the basis of clinical findings. Herewith,
Pathogenesis we review all available diagnostic modalities for peritoneal TB.
The postulated mechanisms by which peritoneum can be Purified protein derivative tuberculin skin test
involved are:[24,25] A positive tuberculin skin test has been reported in 24%–100%
1. Reactivation of latent tuberculous foci in the peritoneum, of the cases; this test is diagnostically insignificant, as negative
acquired by hematogeneous spread from a primary lung skin test may be seen in many patients with histologically
focus confirmed peritoneal TB.[14]
2. Hematogeneous spread from active pulmonary, miliary
TB or silent bacteremia during the primary phase of TB Ascitic fluid analysis
3. Direct spread from infected organs such as intestine, Biochemistry and cytology
fallopian tubes and rupture of a tuberculous intra‑abdominal The typical analysis of ascitic fluid from patients with peritoneal
lymph node TB demonstrates high protein concentration  (>3 g/dl) with
4. Through lymph channels from infected abdominal lymph serum to ascites albumin gradient of <1.1 g/dl and predominant
nodes. Abdominal lymph nodal and peritoneal TB may lymphocytic pleocytosis.[14] Predominance of neutrophils,
occur without gastrointestinal involvement. however, may be observed in patients undergoing peritoneal
dialysis.[11,14,27,28]
Pathology
Microbiology
Peritoneal TB occurs in three forms:  (1) wet type with Identification of Acid‑fast bacilli in the ascitic fluid through
ascites,  (2) encysted  (loculated) type with a localized both smear and culture methods remains a useful mean to
abdominal swelling, and  (3) fibrotic type with abdominal diagnose peritoneal TB. However, acid‑fast smear of ascitic
masses composed of mesenteric and omental thickening, fluid has a low yield with a reported sensitivity of 0%–6%,[29]
with matted bowel loops, felt as lumps in the abdomen. while the frequency of a positive culture for M. tuberculosis
Considerable overlap of these types can be observed.[25] was 2%–50%.[14‑22] Techniques to improve the diagnostic
Grossly, the peritoneum is studded with multiple yellow‑white yield of TB culture in the peritoneal fluid were attempted.
tubercles  (<5  mm) scattered over the visceral and parietal Singh et al. assumed that 1 L of ascitic fluid can provide up
peritoneum.[23‑25] In addition, the peritoneal lining along with to 83% of positive results.[24] This technique is impractical as
the omentum and mesentery is thickened and adhesions this large amount of fluid needs special centrifuge machines.
develop with abdominal organs. Microscopically, the tubercles Interestingly, conventional mycobacterial culture takes up to
composed of numerous, large, confluent granulomas of 4–6 weeks to achieve results, even with liquid culture methods
variable size, composed of epithelioid cells, with a peripheral the process requires at least 12 days. This delay may increase
zone of lymphocytes and Langhan’s giant cells with central morbidity and therefore, other diagnostic tools for early
caseous necrosis and surrounding fibrosis are seen.[26] diagnosis of TB are needed.
Carbohydrate antigen 125
Causative Agent Previous reports have noted that carbohydrate antigen
Mycobacterium tuberculosis causes most of the cases; however, 125 (CA‑125) is not crucial in differentiating malignancy and
Mycobacterium bovis has been identified in few reports.[5,21,23] TB since ascitic CA‑125 levels also increase in other diseases
with peritoneal involvement.[30]
Clinical Features Polymerase chain reaction techniques
The clinical manifestations of peritoneal TB are quite protean, The performance of conventional polymerase chain
nonspecific and mimic many diseases and pathological reaction (PCR) was disappointing. Recently, modified PCR

4 Libyan Journal of Medical Sciences  ¦  Volume 2  ¦  Issue 1  ¦  January-March 2018

[Downloaded free from http://www.ljmsonline.com on Tuesday, March 27, 2018, IP: 49.207.54.199]

Khan: Peritoneal tuberculosis: Advances and controversies

techniques (The GeneXpert MTB/RIF assay, real‑time PCR blind percutaneous peritoneal biopsy, transabdominal
and nested PCR) have been used by many authors for early sonographic, or CT‑guided peritoneal biopsy and laparotomy or
detection of Mycobacterium in ascitic fluid; however, their laparoscopic biopsy.[50] Laparoscopy with directed biopsy is an
role is not firmly established as the obtained results are excellent tool for diagnosing tuberculous peritonitis. It is safer
non‑conclusive.[31‑33] and provides better inspection, as well as it allows a shorter
hospital stay, rapid postoperative recovery, and quick return
Biomarkers to social activities. Characteristic laparoscopic appearance
Other rapid and noninvasive tests for the diagnosis of includes free ascites, multiple yellowish‑white nodules or
peritoneal TB had been attempted. Measurement of adenosine tubercles on visceral and parietal peritoneum, peritoneal or
deaminase  (ADA) and gamma interferon  (IFN‑γ), in the visceral adhesion, and occasionally inflamed hemorrhagic
supernatant of fluid specimens has been used to diagnose areas on the peritoneum.[50‑53] It was reported that macroscopic
peritoneal TB. However, literature review showed that picture of peritoneum during laparoscopy was suggestive of
despite being helpful in peritoneal TB diagnosis, neither of TB in 85%–100% of the cases and laparoscopically guided
these modalities is proved to be reliable for replacing the peritoneal biopsy had detected caseating granulomas in
peritoneal biopsy.[14,33‑37] 76%–100% of patients.[14,50‑53] Microbiological studies of biopsy
The enzyme‑linked immunospot assay should be performed in all cases to identify nontuberculous
A number of studies have now reported that the ELISPOT mycobacteria (especially in patients on continuous ambulatory
assay may be a useful tool to diagnose peritoneal TB in peritoneal dialysis), to detect drug resistance TB and to increase
smear‑negative ascites by measuring gamma producing T‑cell the diagnostic yield of the procedure, as it may be positive even
responses to early secreted antigenic targets of Mycobacterium in the absence of a characteristic histopathological picture.[14]
TB.[38‑40] although the preliminary results are promising, it is Laparoscopic biopsy specimens reveal Acid‑fast bacilli in
too early to make a final conclusion on their role in diagnosis 3%–25% and cultures were positive for M. tuberculosis in
of peritoneal TB, as more studies are needed. 38%–98%.[14,50‑53] There is lack of data on diagnostic yield of
PCR study for M. tuberculosis on peritoneal biopsy. Although
Abdominal sonography laparoscopic biopsy is safe, it is not free of complications such
Abdominal sonography is the most commonly used first‑line as intestinal perforation and hemorrhage.[51]
imaging modality for evaluating patients with suspected
peritoneal TB as it can easily assess the peritoneum.[41] The most Treatment and Prognosis
common findings include multiple thin septae, visible debris
The currently recommended regimen for treatment of
of different densities within the fluid. Other findings include
peritoneal TB is largely similar to treatment for TB elsewhere
peritoneal thickening and nodularity.[41‑43] As illustrated in
and includes the “4‑drug regimen;” an initial phase of 2 months
many reports, these findings lack specificity and are not useful
followed by a continuation phase of 4 months. Treatment in
for differentiating peritoneal TB from other diseases such as
the 2‑month phase is usually including daily administration
peritoneal carcinomatosis.[14,41] However, abdomen sonography
of rifampicin, isoniazid; pyrazinamide and ethambutol or
can be used to guide abdomen tapping and peritoneal biopsy.
streptomycin. If the isolate is susceptible to rifampicin and
Abdominal computed tomography isoniazid, pyrazinamide, and ethambutol can be discontinued
Abdominal computed tomography  (CT) assists in the followed by a continuation phase where isoniazid and
identification of peritoneal diseases. Common CT Abnormalities rifampicin are again given daily for 4  months. Although
that are seen in most patients with peritoneal TB include the disease usually responds to this standard anti‑TB drug
peritoneal thickening, free and loculated ascites. Other therapy,[14‑23] the optimal duration of therapy is debatable.
findings include mesenteric or omental thickening, mesenteric Some physicians use antituberculous therapy for 9–12 months
or omental strand, and mesenteric or omental nodes.[44‑48] without any scientific justification. In our experience, anti‑TB
Although these findings are nonspecific, in our experience and drug therapy can be used for 9 months or 12 months in a patient
in view of available data, these findings may suggest peritoneal who uses second‑line therapy due to drug resistance or drug
TB and their absence may at least argue against it. sensitivity. Duration of therapy also can be extended because
of side effect developed during treatment. Corticosteroid
A positron emission tomography/computed tomography administration combined with anti‑TB treatment has been
scan advocated by some researchers to reduce the complications;
Recent data show that PET/CT findings in the parietal however, there is a controversy about the benefit that can be
peritoneum are useful for differentiating between peritoneal obtained.[14]
TB and peritoneal carcinomatosis.[49] However, further large
prospective studies are needed to confirm these findings. Conclusions
Peritoneal biopsy Available data show that there is no specific sign or symptom
Peritoneal biopsy gives a better diagnostic value than ascitic for the diagnosis of peritoneal TB. A high index of suspicion is
fluid alone. It can be obtained by different procedures including always required. Peritoneal TB should be considered early as

Libyan Journal of Medical Sciences  ¦  Volume 2 ¦ Issue 1 ¦ January-March 2018 5

[Downloaded free from http://www.ljmsonline.com on Tuesday, March 27, 2018, IP: 49.207.54.199]

Khan: Peritoneal tuberculosis: Advances and controversies

a differential diagnosis in patients who have unexplained low using diagnostic laparoscopy in clinically suspected cases. Ann King
gradient ascites with high lymphocytes. The role of advanced Edward Med Univ 2014;20:176‑81.
18. Makhlouf  NA, Makhlouf  GA, Soliman  A, Sherif  MF, Rashed  HA.
diagnostic modalities such as modified PCR techniques and Diagnostic challenges of tuberculosis peritonitis in upper Egypt. Al
biomarkers remain controversial. Laparoscopically guided Azhar Assiut Med J 2016;14:115‑21.
peritoneal biopsy remains the best diagnostic tool in our 19. Dülger AC, Karadaş S, Mete  R, Türkdoğan MK, Demirkıran D,
hand nowadays as it provides a rapid and correct diagnosis, Gültepe B, et al. Analysis of cases with tuberculous peritonitis:
A single‑center experience. Turk J Gastroenterol 2014;25:72‑8.
therefore, it should be performed early in suspected cases. Six 20. Thoreau N, Fain O, Babinet P, Lortholary O, Robineau M, Valeyre D,
months of treatment with the 4‑drug regimen is effective and et al. Peritoneal tuberculosis: 27 cases in the suburbs of Northeastern
markedly improves the outcome. Paris. Int J Tuberc Lung Dis 2002;6:253‑8.
21. Cavalli  Z, Ader  F, Valour  F, Saison  J, Boussel  L, Dumitrescu  O,
Financial support and sponsorship et al. Clinical presentation, diagnosis, and bacterial epidemiology of
Nil. peritoneal tuberculosis in two university hospitals in France. Infect Dis
Ther 2016;5:193‑9.
Conflicts of interest 22. Chau  TN, Leung  VK, Wong  S, Law  ST, Chan  WH, Luk  IS, et al.
Diagnostic challenges of tuberculosis peritonitis in patients with and
There are no conflicts of interest. without end‑stage renal failure. Clin Infect Dis 2007;45:e141‑6.
23. Vaid U, Kane GC. Tuberculous peritonitis. Microbiol Spectr 2017;5.
Doi: 10.1128/microbiolspec.TNMI7-0006-2016.
References 24. Singh  MM, Bhargava  AN, Jain  KP. Tuberculous peritonitis. An
1. WHO. Global Tuberculosis; 2016. Available from: http://www.who. int/ evaluation of pathogenetic mechanisms, diagnostic procedures and
tb/publications/global_report/en/. [Last accessed on 2017 Mar 01]. therapeutic measures. N Engl J Med 1969;281:1091‑4.
2. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc 25. Sharma  MP, Bhatia  V. Abdominal tuberculosis. Indian J Med Res
Respir Dis (Seoul) 2015;78:47‑55. 2004;120:305‑15.
3. Orcau À, Caylà JA, Martínez JA. Present epidemiology of tuberculosis. 26. Dasgupta  A, Singh  N, Bhatia  A. Abdominal tuberculosis:
Prevention and control programs. Enferm Infecc Microbiol Clin A histopathological study with special reference to intestinal perforation
2011;29 Suppl 1:2‑7. and mesenteric vasculopathy. J Lab Physicians 2009;1:56‑61.
4. Jehangir W, Khan R, Gil C, Baruiz‑Creel M, Bandel G, Middleton JR, 27. Karayaylali  I, Seyrek  N, Akpolat  T, Ateş K, Ozener  C, Yilmaz  ME,
et al. Abdominal tuberculosis: An immigrant’s disease in the United et al. The prevalence and clinical features of tuberculous peritonitis in
States. N Am J Med Sci 2015;7:247‑52. CAPD patients in turkey, report of ten cases from multi‑centers. Ren
5. Guirat  A, Koubaa  M, Mzali  R, Abid  B, Ellouz  S, Affes  N, et al. Fail 2003;25:819‑27.
Peritoneal tuberculosis. Clin Res Hepatol Gastroenterol 2011;35:60‑9. 28. Waness  A, Al Shohaib  S. Tuberculous peritonitis associated with
6. Ködmön C, Zucs P, van der Werf MJ. Migration-relat¬ed tuberculosis: peritoneal dialysis. Saudi J Kidney Dis Transpl 2012;23:44‑7.
Epidemiology and characteristics of tuberculosis cases originating 29. Chow  KM, Chow  VC, Hung  LC, Wong  SM, Szeto  CC. Tuberculous
outside the European Union and European Economic Area, 2007 to 2013. peritonitis‑associated mortality is high among patients waiting for the
Euro Surveill 2016;21. Doi: 10.2807/1560-7917.ES.2016.21.12.30164. results of mycobacterial cultures of ascitic fluid samples. Clin Infect Dis
7. Min JY, Bang SY, Min SY, Lee DS, Kim BS, Kim JE, et al. A case of 2002;35:409‑13.
peritoneal tuberculosis developed after infliximab therapy for refractory 30. Tong H, Tai Y, Ye C, Wu H, Zhang LH, Yan ZP, et al. Carbohy¬drate
RA. Tuberc Respir Dis (Seoul) 2012;73:234‑8. antigen 125 and carcinoembryonic antigen in the differentiation of
8. Sharma  SK, Mohan  A, Kadhiravan  T. HIV‑TB co‑infection: tuberculous peritonitis and peri¬tonitis carcinomatosa. Oncotarget
Epidemiology, diagnosis&amp; management. Indian J Med Res 2017;8:78068-75.
2005;121:550‑67. 31. Rufai  SB, Singh  S, Singh  A, Kumar  P, Singh  J, Vishal  A, et al.
9. Cho  YJ, Lee  SM, Yoo  CG, Kim  YW, Han  SK, Shim  YS, et al. Performance of xpert MTB/RIF on ascitic fluid samples for detection of
Clinical characteristics of tuberculosis in patients with liver cirrhosis. abdominal tuberculosis. J Lab Physicians 2017;9:47‑52.
Respirology 2007;12:401‑5. 32. Furini AA, Pedro Hda S, Rodrigues JF, Montenegro LM, Machado RL,
10. Aguado JM, Pons F, Casafont F, San Miguel G, Valle R. Tuberculous Franco C, et al. Detection of Mycobacterium tuberculosis complex by
peritonitis: A study comparing cirrhotic and noncirrhotic patients. J Clin nested polymerase chain reaction in pulmonary and extrapulmonary
Gastroenterol 1990;12:550‑4. specimens. J Bras Pneumol 2013;39:711‑8.
11. Quantrill  SJ, Woodhead  MA, Bell  CE, Hutchison  AJ, Gokal  R. 33. Flores LS, Solís AH, Gutiérrez AE, José LC, Ortiz IC, González HG,
Peritoneal tuberculosis in patients receiving continuous ambulatory et al. Peritoneal tuberculosis: A persistent diagnostic dilem¬ma, use
peritoneal dialysis. Nephrol Dial Transplant 2001;16:1024‑7. complete diagnostic methods. Rev Med Hosp Gen Méx 2015; 78:55-61.
12. Sanai  FM, Bzeizi  KI. Systematic review: Tuberculous 34. Su SB, Qin SY, Guo XY, Luo W, Jiang HX. Assessment by meta‑analysis
peritonitis  –  Presenting features, diagnostic strategies and treatment. of interferon‑gamma for the diagnosis of tuberculous peritonitis. World
Aliment Pharmacol Ther 2005;22:685‑700. J Gastroenterol 2013;19:1645‑51.
13. Kocaman O, Danalioğlu A, İnce AT, Tozlu M, Şentürk H. Diagnosis of 35. Patel SM, Sweetser S. The wet‑ascitic form of tuberculous peritonitis.
tuberculous peritonitis using endoscopic ultrasound‑guided fine‑needle Hepatology 2011;54:364‑5.
aspiration biopsy of the peritoneum. Turk J Gastroenterol 2013;24:65‑9. 36. Zaki  ME, Foad  MF, El‑Deeb  DR, Abo El‑Kheir  MY. Diagnostic
14. Khan  FY, Al‑Muzrakchi  AM, Elbedawi  MM, Al‑Muzrakchi  AA, performance of gamma interferon in rapid diagnosis of tuberculosis
Al Tabeb A. Peritoneal tuberculosis in Qatar: A five‑year hospital‑based peritonitis. Int J Curr Microbiol App Sci 2015;4:1‑13.
study from 2005 to 2009. Travel Med Infect Dis 2012;10:25‑31. 37. Chander A, Shrestha CD. Diagnostic significance of ascites adenosine
15. Manohar A, Simjee AE, Haffejee AA, Pettengell  KE. Symptoms and deaminase levels in suspected tuberculous peritonitis in adults.
investigative findings in 145  patients with tuberculous peritonitis J Microbiol Infect Dis 2013;3:104‑8.
diagnosed by peritoneoscopy and biopsy over a five year period. Gut 38. Liu  Z, Zhang  Q, Li  Q, Wang  L, Ren  L. Application of interferon‑γ
1990;31:1130‑2. release assay in extrapulmonary tuberculosis diagnosis, T‑lymphocyte
16. El Abkari  M, Benajah  DA, Aqodad  N, Bennouna  S, Oudghiri  B, regulation, and efficacy evaluation in Northwest China. Int J Clin Exp
Ibrahimi  A, et al. Peritoneal tuberculosis in the Fes University Pathol 2017;10:3885‑94.
Hospital  (Morocco). Report of 123  cases. Gastroenterol Clin Biol 39. Kim SH, Cho OH, Park SJ, Ye BD, Sung H, Kim MN, et al. Diagnosis
2006;30:377‑81. of abdominal tuberculosis by T‑cell‑based assays on peripheral blood
17. Sattar Z, Iqbal M, Gondal KM. The frequency of peritoneal tuberculosis and peritoneal fluid mononuclear cells. J Infect 2009;59:409‑15.

6 Libyan Journal of Medical Sciences  ¦  Volume 2  ¦  Issue 1  ¦  January-March 2018

[Downloaded free from http://www.ljmsonline.com on Tuesday, March 27, 2018, IP: 49.207.54.199]

Khan: Peritoneal tuberculosis: Advances and controversies

40. Lee JY, Kim SM, Park SJ, Lee SO, Choi SH, Kim YS, et al. A rapid carcinomatosis. J Med Assoc Thai 2012;95:1449‑56.
and non‑invasive 2‑step algorithm for diagnosing tuberculous peritonitis 47. Shim SW, Shin SH, Kwon WJ, Jeong YK, Lee JH. CT differentiation
using a T cell‑based assay on peripheral blood and peritoneal fluid of female peritoneal tuberculosis and peritoneal carcinomatosis from
mononuclear cells together with peritoneal fluid adenosine deaminase. normal‑sized ovarian cancer. J Comput Assist Tomogr 2017;41:32‑8.
J Infect 2015;70:356‑66. 48. Ha  HK, Jung  JI, Lee  MS, Choi  BG, Lee  MG, Kim  YH, et al. CT
41. Hanbidge AE, Lynch D, Wilson SR. US of the peritoneum. Radiographics differentiation of tuberculous peritonitis and peritoneal carcinomatosis.
2003;23:663‑84. AJR Am J Roentgenol 1996;167:743‑8.
42. Tongsong T, Sukpan K, Wanapirak C, Sirichotiyakul S, Tongprasert F. 49. Wang  SB, Ji  YH, Wu  HB, Wang  QS, Zhou  WL, Lv  L, et al.
Sonographic features of female pelvic tuberculous peritonitis. PET/CT for differentiating between tuberculous peritonitis and peritoneal
J Ultrasound Med 2007;26:77‑82. carcinomatosis: The parietal peritoneum. Medicine  (Baltimore)
43. Akhan  O, Demirkazik  FB, Demirkazik  A, Gülekon N, Eryilmaz  M, 2017;96:e5867.
Unsal  M, et al. Tuberculous peritonitis: Ultrasonic diagnosis. J  Clin 50. Chow  KM, Chow  VC, Szeto  CC. Indication for peritoneal biopsy in
Ultrasound 1990;18:711‑4. tuberculous peritonitis. Am J Surg 2003;185:567‑73.
44. Na‑ChiangMai  W, Pojchamarnwiputh  S, Lertprasertsuke  N, 51. Abid H, Charif I, Mellouki I, Aqodad D, Benajah A, Ibrahim A, et al.
Chitapanarux T. CT findings of tuberculous peritonitis. Singapore Med Role of laparoscopy in diagnosis of peritoneal tuberculosis (About 414
J 2008;49:488‑91. cases). Open J Gastroenterol 2013;3:205-7.
45. Vázquez Muñoz E, Gómez‑Cerezo  J, Atienza Saura  M, 52. Abdelaal  A, Alfkey  R, Abdelaziem  S, Abunada  M, Alfaky  A,
Vázquez Rodriguez  JJ. Computed tomography findings of peritoneal Ibrahim  WH, et al. Role of laparoscopic peritoneal biopsy in the
tuberculosis: Systematic review of seven patients diagnosed in diagnosis of peritoneal tuberculosis. A  seven‑year experience.
6 years (1996‑2001). Clin Imaging 2004;28:340‑3. Chirurgia (Bucur) 2014;109:330‑4.
46. Charoensak  A, Nantavithya  P, Apisarnthanarak  P. Abdominal CT 53. Saxena P, Saxena S. The role of laparoscopy in diagnosis of abdominal
findings to distinguish between tuberculous peritonitis and peritoneal tuberculosis. Int Surg J 2016;3:1557‑63.

Libyan Journal of Medical Sciences  ¦  Volume 2 ¦ Issue 1 ¦ January-March 2018 7

View publication stats