Place of Laparoscopy in Peritoneal Tuberculosis.

Introduction: Peritoneal tuberculosis (PT) is a rare form of extrapulmonary tuberculosis in children. The diagnosis is difficult because of its clinical polymorphism. Laparoscopy is the gold standard to make the diagnosis by exploring and performing peritoneal biopsies. Our aim was to show the place of laparoscopy in the diagnosis of PT, to compare the anatomopathological results of peritoneal biopsies with a macroscopic appearance to quick start antituberculosis treatment. Case Reports: We reported 4 patients with PT, 3 girls and 1 boy. The middle age was 9 years old. The revealing symptomatology was ascites in all cases. Radiological exploration was not contributing. Laparoscopy was performed for all patients. The exploration revealed an agglutination of the intestinal loops with the presence of whitish micronodules scattered over the entire abdominal cavity. Peritoneal biopsies were done in all cases. Histological examination confirmed the diagnosis of PT in all patients and antituberculosis treatment was introduced. There was a good clinical evolution with a follow-up of 30 months. Conclusion: PT is a public health problem due to its clinical and biological polymorphism. Laparoscopy with peritoneal biopsies remains the essential means for the diagnosis of this pathology in children.

Diaphragmatic eventration in children.

BACKGROUND: Diaphragmatic eventration (ED) is a rare anomaly defined by a permanent elevation of a hemidiaphragm without defects. Clinical manifestations are diverse, ranging from asymptomatic to life-threatening respiratory distress. The aim of this study is to report our experience of management of eight children with ED over the past 15 years. METHODS: A retrospective study was conducted involving 8 infants and children with ED managed at the department of pediatric surgery of Tunis Children's Hospital. RESULTS: Five patients (2 males, 3 females) whose ages ranged from 5 month to 7 years (mean, 13 months) were operated on using diaphragmatic plication (3 right-sided and 2 left-sided plications) for symptomatic ED with a dramatic improvement in their respiratory status. Another infant (a 3-month-old boy) was admitted for respiratory distress that required mechanical ventilatory support. He died before operation because of sepsis. Two other asymptomatic patients with incidentally diagnosed ED were followed up for 5 years on average. Chest x-ray suggested eventration in all cases. Ultrasound was found to be a useful modality for diagnosis in 6 cases. There were no cases of associated malformation. CONCLUSION: Diaphragmatic eventration in children is usually congenital but may be acquired. Chest ultrasound is an important imaging modality for diagnosis. Diaphragmatic plication appears to be safe and effective. Surgical intervention is not recommended in asymptomatic patients.