Tuberculous peritonitis following intestinal perforation in malignancy

SUMMARY Tuberculous peritonitis is one of the most common causes of exudative ascites, especially in the young, and is an important cause of extra-pulmonary disease. However, tuberculous peritonitis is challenging to diagnose because there are no pathognomonic clinical features or imaging findings. Therefore, it is commonly misdiagnosed as another type of peritoneal disease, especially so in elderly patients with malignant disease. In this report, we described two cases of tuberculous peritonitis that were observed after intestinal perforation in elderly patients with malignancies. These diagnoses were established by laparoscopic peritoneal biopsy or AFB cultures of the ascitic fluid. Both patients were treated with anti-TB medications.

Role of enteric fever in ileal perforations: an overstated problem in tropics?

PURPOSE: To determine the role of enteric fever in ileal perforations. METHODS: A prospective cohort of 47 patients of ileal perforation was subjected to clinical examination and investigations for APACHE II scoring. Blood, ulcer edge biopsy, mesenteric lymph node and peritoneal aspirate were subjected to culture to determine the predominant aerobic bacterial isolate and its antibiogram. RESULTS: Seven patients (14.9%) required intensive care and seven (14.9%) developed septicaemia. Mortality was 17%. Highest isolation rate was seen in ulcer edge (70.2%) followed by lymph node (66%) culture. The bacterial spectrum was Escherichia coli (23.4%), Enterococcus faecalis (21.3%), Salmonella enterica serovar Typhi (6.3%), Salmonella enterica serovar Paratyphi A (4.2%), etc. CONCLUSIONS: Enteric fever organisms are not the predominant causative agents of ileal perforations. Culture of ulcer edge biopsy, lymph node is crucial for aetiological diagnosis. The use of APACHE II triaging and prescription of antimicrobials based on the local pattern of susceptibility profile of the aetiological agent is recommended.

Neonatal gastrointestinal mucormycosis--a case report.

Mucormycosis is a rare opportunistic fungal infection. It occurs mainly in immunocompromised patients and is usually fatal in children. This fungus can affect central nervous system, nasopharynx, lungs, skin and gastrointestinal tract. It invades the blood vessels and causes thrombosis, leading to infarction of the surrounding tissues. The diagnosis depends mainly on histopathological examination and demonstration of the fungus in the tissue sections, therefore a high index of suspicion and early exploration is required. We report a case of malnourished child who presented with perforation peritonitis. Investigations revealed very low total serum proteins and raised serum creatinine and blood urea levels. On exploratory laparotomy three perforations were located in the gastrointestinal tract. Histopathlogical examination of the perforation edge sections showed characteristic fungal hyphae confirming the diagnosis of gastrointestinal mucormycosis.

Tuberculosis--an underestimated cause of ileal perforation.

One hundred and thirteen specimens of Ileum received over the last 3 years (1990-92) were reviewed histologically and analysed to determine the aetiology of perforation. Perforations were seen in all age groups varying from one month to 75 years with a peak incidence during 3rd and 4th decades. Males were more frequently affected. Perforations were single or multiple involving the whole ileum. The highest incidence (52) was seen in enteric fever. Next in frequency (19) was tuberculosis. In 23 cases no specific aetiology could be identified. Other causes of perforation were injury and obstruction resulting from diverticulosis, intussusception adhesions and worms. A significantly high incidence (16.8%) of tuberculous perforation is noteworthy.