Peritonitis Tuberculosis

Disusun oleh :
Afina Faza
Agnita Putri F
Etika Dika N
Nur Rahmi S

Preseptor :
Dr. Liza Nursanty.,SpB
 Definition
• Inflammation of the visceral and parietal
peritoneum. The inflammation can be
localized or diffuse caused by
Mycobacterium Tuberculosis
 Epidemiology
• affects nearly one third of the world's
population
• approximately 9 million new cases of
tuberculosis are reported annually
worldwide and almost 2 million
tuberculosis-related deaths occur—more
than for any other single infectious disease
 Risk Factors
• Elderly
• In most large urban centers, reported
cases of tuberculosis are more numerous
among the homeless, prisoners, and drug-
addicted populations.
• Tuberculosis in immunocompromised
patients
 Etiology
• Mycobacterial species are obligate
aerobes
• Mycobacterium tuberculosis is the highly
virulent bacillus of this species that
produces invasive infection among
humans, principally pulmonary
tuberculosis.
 Pathogenesis
1 Formation of Spread into
Infection of epitheloid Ulceratinon lymphnode,
Ingestion of
mucosal tubercles in Caseous of the pertioneum,
infected milk
layer of the the lymphoid necrosis overlying portal
or sputum
GI tract tissue of the mucosa circulation
submucosa (hepar)

2
Hematogenous spread
from tuberculous focus
from elsewhere in the body

3 Fallopian tube, adnexa,

Direct spread into
Psoas abcess, Tb
peritoneum
spondilitis
 Clinical Manifestation
• Abdominal pain
• Weight loss
• Anemia
• Fever with night sweats
• Patients may present with symptoms ofobstruction, right iliac fossa pain, or
a palpable mass in the right iliac fossa

Class :
1) Wet Ascitic type : Free or loculated fluid in abdomen
2) Fixed Fibrotic type : - Involvement of omentum and mesentery
(uncommon)
-Peresence of matted bowel loops on imaging
-Loculated ascite
3) Dry plastic type : - Fibrous peritoneal reaction, peritoneal nodule
and presence of ahesion
 Clinical Manifestation
• abdominal pain,
• fever,
• loss of weight,
• ascites,
• night sweats,
• Rigidity of abdominal wall
• Absent of bowel sound
 Diagnosis
• Tuberculin test may positive
• Ultrasonography
– Intra-abdominal fluid
– Club sandwich or sliced bread sign is due to
localized fluid between radially oriented bowel
loops, due to local exudation from the
inflamed bowel
– Bowel wall thickening
• Laparotomy
• Ascitic fluid examination
– the ascitic fluid is straw colored with protein
>3g/dl, and total cell count of 150-4000/ìl,
consisting predominantly of lymphocytes
(>70%). The ascites to blood glucose ratio is
less than 0.96 and serum ascites albumin
gradient is less than 1.1 g/dl.
 Treatment
• CT is an excellent way to diagnose and
view the extent of tuberculous peritonitis.
• Treatment for this condition is largely
similar to treatment for tuberculosis
elsewhere, and a multidrug protocol is
used.
 Reference
• Schwartz’s Principle of Surgery ed. 9