Difficulty in diagnosing peritonitis caused by multidrug-resistant tuberculosis.

Key Clinical Message: The low sensitivity of ascites culture for acid-fast bacilli necessitates a peritoneal biopsy when tuberculous peritonitis is suspected. Findings in the peritoneum on computed tomography may prompt suspicion of tuberculous peritonitis. Abstract: A 47-year-old Nigerian man presented with fever, abdominal distention, and weight loss. Abdominal computed tomography revealed massive ascites and peritoneal thickening. Despite failing to culture acid-fast bacilli from ascites, histological examination and culture of peritoneum revealed multidrug-resistant tuberculosis peritonitis. Peritoneal biopsy is mandatory when tuberculosis peritonitis is suspected.

Pathophysiology of encapsulating peritoneal sclerosis: lessons from findings of the past three decades in Japan.

Encapsulating peritoneal sclerosis (EPS), a condition with a high mortality rate, is a serious complication of peritoneal dialysis (PD). In Japan, EPS became a central issue in the clinical setting during the mid-90s and the beginning of this century. However, following the introduction of biocompatible neutral PD solutions containing lower levels of glucose degradation products, the incidence and clinical severity of EPS has been greatly lessened. During the past three decades, the etiology of EPS has been elucidated by findings obtained by peritoneal biopsy, laparoscopy, and surgical intervention. Accumulating findings suggest the need for a paradigm change on the nature of EPS pathophysiology; notably, EPS appears not to reflect peritoneal sclerosis per se, but rather the formation of a neo-membrane as a biological reaction to peritoneal injury. This narrative review looks back on the history of EPS in Japan, and discusses EPS pathophysiology, the impact of neutral PD solution on peritoneal protection, and a future novel diagnostic approach, ultra-fine endoscope, for the identification of patients at high risk of EPS.

"Omental Cake" in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma.

We report a case of a 68-year-old man with medical history of pleural asbestosis and diagnosed with malignant peritoneal mesothelioma. This neoplasm is rare, has a poor prognosis, and is associated with asbestosis in many cases. It manifests clinically insidiously and in relation to the intra-abdominal locoregional effect. Radiological findings are variable, although the finding of "omental cake" by CT scan is characteristic but not pathognomonic, as seen in our case. A biopsy is required for the diagnosis, which can be guided by radiology or surgery. Treatment options available are cytoreductive surgery with intraperitoneal hyperthermic chemotherapy or systemic chemotherapy. However, new therapeutic options are emerging, which are still under development and research.

The role of laparoscopic staging for the management of gastric cancer.

AIM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSIONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods.

Tuberculosis in an Immunocompetent Immigrant Patient.

Peritoneal tuberculosis (TB) is a rare medical condition in developed nations like the United States, and it is uncommon to observe this condition in patients without underlying immunosuppression. This report describes a patient who developed abdominal pain, constipation, and ascites. And later on, he was diagnosed with peritoneal TB following laparoscopy with peritoneal biopsy. The patient was an immigrant from a high TB burden country but had no other common risk factors for the development of peritoneal TB. Treatment with anti-TB therapy resulted in significant clinical improvement.

Tuberculosis peritoneal. Caso clínico diagnosticado por laparoscopia / Peritoneal tuberculosis. Use of laparoscopy in the diagnosis

RESUMEN Se presenta el caso de un paciente diabético de 55 años de edad internado en la sala de Medicina Interna del Hospital Pablo Arturo Suárez de Quito - Ecuador, que acude con un síndrome febril de 8 días de evolución que se prolongó durante la hospitalización a más de 35 días sin causa o foco aparente, a pesar del tratamiento antipirético, acompañado de dolor abdominal difuso, pérdida de peso (aproximadamente 8 kg en 3 meses) y ascitis. Se investigó las posibles etiologías, incluyendo pruebas de alta sensibilidad y especificidad para tuberculosis como (Cuantiferon GOLD Tb), adenosina deaminasa (ADA), que resultó falsa-negativa. El diagnóstico se confirmó mediante biopsia peritoneal de una muestra obtenida por laparoscopia exploratoria como último recurso diagnóstico. La tuberculosis peritoneal es una enfermedad que ocurre por la reactivación de los focos tuberculosos latentes en el peritoneo, debido a la diseminación hematógena, linfática o por contigüidad a un foco primario; más del 90% de los pacientes tienen ascitis en el momento de la presentación y un 10% presenta una fase "seca" más avanzada con un abdomen "pastoso" (es una forma de enfermedad fibroadhesiva).Palabras claves: tuberculosis peritoneal, ascitis, síndrome febril prolongado, biopsia peritoneal, falsos negativos en pruebas diagnósticas de tuberculosis

ABSTRACT The case of a diabetic patient of 55 years of age is presented in the internal medical room of Pablo Arturo Suarez Hospital of Quito - Ecuador, the same comes with a febril syndrome of 8 days of evolution that prolonged during the hospitalization to more of 35 days without cause or apparent focus despite the antipyretic treatment, accompanied by diffuse abdominal pain, weight loss and ascitis, where the possible etiologies were investigated, including tests of high sensitivity and specificity for tuberculosis as (quantiferon), resulting false negative, confirming the diagnosis through peritoneal biopsy of a sample obtained by exploratory laparoscopy as a last diagnostic resource. Peritoneal tuberculosis is a disease that occurs by the reactivation of latent tuberculosous focus in the peritoneum, established by hematogen, lymphatic or contiguous dissemination of a primary focus, where more than 90% of patients have ascitis at the time of presentation, and a 10% present a more advanced "dry" phase with a "pastoso" abdomen, representing a form of fibroadhesive disease.Keywords:peritoneal tuberculosis, ascites, prolonged febrile syndrome peritoneal biopsy, false negatives in diagnostic tests for tuberculosis.

Clinical research of transgastric approach transluminal endoscopic surgery in diagnosing unexplained ascites / 重庆医学

Objective To explore the clinical value of transgastric natural orifice transluminal endoscopic surgery(NOTES)in diagnosing unexplained ascites.Methods The clinical data in 12 cases of unexplained ascites diagnosed by adopting transgastric approach NOTES and performed abdominal exploration and peritoneal biopsy in our hospital from November 2015 to July 2016 were retrospectively analyzed.The operative risk and clinical application value were evaluated by statistically analyzing the postoperative complications occurrence and the diagnosis rate of disease.Results The definite diagnosis rate reached 100％ verified by pathology after abdominal exploration and peritoneal biopsy,in which 8 cases(66.7％)were tuberculous peritonitis,2 cases(16.7％)were liver cirrhosis,1 case(8.3％)was peritoneal mesothelioma,1 cases(8.3％)was peritoneal metastatic carcinoma;2 cases appeared abdominal pain after operation,including 1 case of neutrophil ratio increase,symptoms and persistent time of abnormal laboratory indexes did not exceed 24 h,the incidence rate was 8.3％;no complications of abdominal cavity infection,incision bleeding and puncture site fistula occurred.Conclusion The transgastric NOTES for conducting abdominal exploration and peritoneal biopsy in the diagnosis of unexplained ascites has the advantages of small trauma,less complications and rapid postoperative recovery,possesses an important clinical application value.

Clinical Presentation, Diagnosis, and Bacterial Epidemiology of Peritoneal Tuberculosis in Two University Hospitals in France.

INTRODUCTION: Diagnosis of peritoneal tuberculosis (pTB) is difficult, even in developed countries, where data are lacking. The aim of the present study was to describe the clinical presentation, diagnosis, and bacterial epidemiology of pTB in France over a 10-year period. METHODS: A retrospective study was conducted on pTB in two university hospitals in France, between January 2004 and December 2014. RESULTS: Among the 34 patients, 76.5% were migrants from areas of endemic tuberculosis (TB), mainly Africa. The main presentation (85.3%) was a checkup of ascites or suspicion of peritoneal carcinomatosis. On abdominal computed tomography, ascites was found in 90.6% and peritoneal thickening in 75%. Surgery was required for diagnosis in 58.8% of patients. Six of the patients who did not undergo surgery had ultrasound-guided peritoneal biopsy. Bacteriology was positive for ascites in only 58.1% of cases, for peritoneal biopsy in 73.3%, while granuloma was found in 95.5%. TB polymerase chain reaction (PCR) was positive in 25% of peritoneal biopsy. Mycobacterium bovis was isolated in 23.1% of cases and Mycobacterium tuberculosis in 76.9%. Isolates were fully susceptible (except M. bovis naturally resistant to pyrazinamide). Many (38%) belonged to the lineage T (genetic analysis by spoligotyping). Cure rate was high (76.5%), after a 6-9 months of anti-tuberculous therapy. CONCLUSION: In developed countries, early diagnosis of pTB is still a challenge. Ultrasound-guided peritoneal biopsy may facilitate diagnosis. TB PCR can be useful on peritoneal biopsy. The lineage T was the most prevalent lineage, but more data are required to directly incriminate this lineage in the pathophysiology of pTB.

Biocompatible Dialysis Solutions Preserve Peritoneal Mesothelial Cell and Vessel Wall Integrity. A Case-Control Study on Human Biopsies.

UNLABELLED: ♦ INTRODUCTION: Chronic exposure to conventional peritoneal dialysis (PD) solutions has been related to peritoneal function alterations in PD patients, and associated with mesothelial cell loss, submesothelial fibrosis, vasculopathy, and angiogenesis. In vitro and ex vivo analyses, as well as studies with animal models, have demonstrated that biocompatible PD solutions attenuate these morphological alterations. Our aim was to confirm the morphological benefits of biocompatible solutions in PD patients. ♦ METHODS: We analyzed biopsies from 23 patients treated with biocompatible solutions (study group, SG), and compared them with a control group (n = 23) treated with conventional solutions (CG), matched for time on PD. ♦ RESULTS: A total of 56.5% of SG patients showed total or partial preservation of mesothelial cells monolayer, in contrast with 26.1% of patients in CG (p = 0.036). Peritoneal fibrosis was not significantly less frequent in SG patients (47.8% SG vs 69.6% CG; p = 0.13). In patients without previous peritonitis, a significantly lower prevalence of fibrosis was present in SG patients (41.7% SG vs 77.8% CG; p = 0.04). Hyalinizing vasculopathy (HV) was significantly lower in SG (4.3% SG vs 30.4% CG; p = 0.02). Cytokeratin-positive fibroblast-like cells were detected in 10 patients (22%), but the prevalence was not significantly lower in SG. In the univariate regression analysis, the use of biocompatible solutions was associated with mesothelial monolayer integrity (p = 0.04) and an absence of vasculopathy (p = 0.04). ♦ CONCLUSION: The present study demonstrates in vivo in human biopsies that biocompatible solutions are better tolerated by the peritoneum in the medium and long term than conventional solutions.

Rare occurrence of fatal Candida haemulonii peritonitis in a diabetic CAPD patient.

A 68-year-old diabetic chronic kidney disease patient on continuous ambulatory peritoneal dialysis for two years developed Candida haemulonii peritonitis without any predisposing factors. There is no effective treatment for this fungus. A peritoneal biopsy showed morphological changes of acute inflammation and chronicity.

The significance of multifunctional peritoneal biopsy needle in the diagnosis of tuberculous peritonitis / 中国实用内科杂志

Objective To identify applied value of multifunctional peritoneal biopsy needle(MPBN)in the diagnosis of tuberculous peritonitis(TP).Methods Peritoneal biopsy was performed with MPBN in 19 cases of 27 patients with TP between January 2001 and September 2005,which was compared with the clinical presentation,laboratory analysis and laparoscopy.Results Five patients were diagnosed as TP according the clinical presentation and laboratory analysis.In 19 patients with TP,73.68% was accurately diagnosed as with MPBN.All of the 3 patients were accurately diagnosed as TP with laparoscopy.Conclusion Peritoneal biopsy with MPBN is useful in diagnosis of tuberculous peritonitis,especially when there is no laparoscope.

Morphological changes of human peritoneum during peritoneal dialysis / 中华肾脏病杂志

Objective To investigate the morphological changes of peritoneum during peritoneal dialysis (PD) and elucidate the possible mechanism of its functional deterioration. Methods Peritoneal biopsies were obtained from normal subjects( n = 10), uremic predialysis patients( n = 12) at catheter insertion and PD patients ( n = 10) at the time of catheter remove or reinsertion or renal transplantation, peritoneal morphology was studied by light microscopy, scanning electron microscopy and transmission electron microscopy. Results Normal peritoneal membrane consisted of a monolayer of mesothelial cells on a basement membrane, and a layer of connective tissue containing cells, blood vessels, lymphatic vessels and so on. Mesothelial cells were polygonal, often elongated, and had numerous microvilli on their luminal surface. Sometimes the microvilli ended with roundish formation or resembled a corona. There were lots of oval or roundish pinocytotic vesicles in the cytoplasm of mesothelial cell. Submesothelial connective tissue contained many collagen and elastic fibers. The peritoneal morphology of uremic predialysis patients was similar to that of normal subjects. But significant abnormalities of peritoneal morphology were observed in PD patients and the changes were progressive. Microvilli were the first site of damage, including microvilli shortening, gradual reduction in number and following total disappearance. Then mesolhelial cell detachment from basement membrane and total disappearances were found. Finally the peritoneal membrane only consisted of submesothelial connective tissue denudation of cells. Conclusions PD can modify peritoneal morphology and structure. The morphological change is progressive and might be one of the important causes of peritoneal failure. Peritoneal biopsy can provide lots of valuable informations about the impact of PD, and thus further study on the relationship between peritoneal structure and its function is very useful for understanding of the physiopathology of peritoneum during PD.