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lüll Tuberculous peritonitis: 43 years expereince in diagnosis and treatment Dineeen P; Homan WP; Grafe WRAnn Surg 1976[Dec]; 184 (6): 717-22The clinical course of 70 patients with tuberculous peritonitis seen over a 43 year period has been reviewed. Thirty-seven patients were diagnosed prior to the advent of anti-tuberculous chemotherapy and 33 after. Clinical manifestations remained unchanged over the period of study. Abdominal pain (93%), fever (63%), gastrointestinal upset (60%), weight loss (60%), and ascites (59%) continue to be the most common findings. Females outnumbered males 2:1. In 89% of patients the duration of symptoms prior to diagnosis was a week or longer, and in 47% it was longer than a month. Diagnosis was confirmed by histologic examination of intra-abdominal tissue in 44% of cases, by clinical suspicion with an extraperitoneal site of tuberculosis in 29%, by bacteriology of peritoneal fluid in 24%, and by autopsy alone in 3%. An extraperitoneal site of tuberculsis was present in 83% of patients. The importance of obtaining a definitive diagnosis, and of instituting immediate antimicrobial therapy is emphasized by the mortality of 49% in the pre-antibiotic era, and of 7% in patients receiving anti-microbial therapy. The conclusions from this review are that: 1) with suggestive clinical manifestations and bacteriologic proof of active tuberculosis anywhere in the patient, operation is not mandated; 2) in the presence of the above clinical manifestations, and in the absence of definitive bacteriologic proof, exploratory laparotomy is indicated for diagnostic purposes; 3) antituberculous chemotherapy is highly effective, and is the treatment of choice.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Antitubercular Agents/therapeutic use[MESH]|Ascites/complications[MESH]|Ascitic Fluid/microbiology[MESH]|Child[MESH]|Child, Preschool[MESH]|Female[MESH]|Humans[MESH]|Infant[MESH]|Male[MESH]|Middle Aged[MESH]|Mycobacterium tuberculosis/isolation & purification[MESH]|Peritonitis, Tuberculous/*diagnosis/drug therapy/mortality[MESH]|Streptomycin/therapeutic use[MESH] |