Diagnostic non invasif d’une tuberculose péritonéale

The place of presumptive diagnosis in the management of peritoneal tuberculosis: A case report from rural Togo

INTRODUCTION AND IMPORTANCE

Tuberculosis is a major public health problem in developing countries. Its main abdominal form is peritoneal. The diagnosis of this peritoneal form is complex and difficult. We describe the role of presumptive diagnosis in the management of this condition in Togo, based on a case study.

CASE PRESENTATION

A security guard with no previous pathological history was seen in consultation with febrile ascites. Investigations revealed the exudative and lymphocytic nature of the ascites. The other investigations did not reveal any other organic lesion, particularly hepatic, or the germ. This typical ascites picture had for us a strong diagnostic value in favour of a tubercular origin. The patient was treated with antituberculosis drugs for 6 months. The evolution was satisfactory.

CLINICAL DISCUSSION

The diagnosis of peritoneal tuberculosis is difficult. Biological explorations are rather disappointing in this approach. Laparoscopy coupled with histological examination represents the best means of diagnosing peritoneal tuberculosis to date. However, in developing countries, the absence of these resources poses a real problem. Clinical and biological arguments are always at the forefront of the diagnosis in endemic countries. The latter is based on the demonstration of febrile, exudative and lymphocytic ascites.

CONCLUSION

The difficult diagnosis of peritoneal tuberculosis coupled with the lack of technical facilities gives the presumptive diagnosis an important place in the management of this condition in endemic countries.

[Role of laparoscopy in the diagnosis of peritoneal tuberculosis in an endemic area of Tunisia]

Tuberculosis is a public health problem in Tunisia. Tataouine governorate is an endemic area. Peritoneal involvement occurs in 1 - 2% of cases. We here report a retrospective, descriptive epidemiological study of 32 patients operated in the Department of Surgery at the Tataouine Hospital between 2010 and 2020. Laparoscopy was mainly performed (28 patients) to take biopsy samples for histologic confirmation of peritoneal tuberculosis. Twenty-four women and 8 men were involved in the study, with a M/F ratio of 0.33. The median age was 43 years, ranging from 14 to 78 years. Diagnostic laparoscopy was performed in 28 cases (87.5%). Given the intraoperative macroscopic aspect, the diagnosis of peritoneal tuberculosis was strongly suspected in 16 patients (50%). The anatomopathological study confirmed the diagnosis in all patients. The purpose of this study is to highlight the epidemiological, clinical features of peritoneal tuberculosis in an endemic region of Tunisia as well as the current role of laparoscopy as a rapid and effective diagnostic procedure.