Tuberculous Peritonitis

Thirty-two patients with tuberculous peritonitis were prospectively studied over a 44-month period at Pahlavi University Medical Center. The hallmarks of the disease included abdominal pain, fever, exudative ascites, and an abdominal mass. The diagnosis of tuberculosis was based on the histological finding of caseating granulomas in 96% of the cases; in 84%, caseating granulomas were found in the peritoneum. Laparotomy appears to be the procedure of choice in obtaining tissue for histopathological diagnosis. Cultures and guinea pig inoculations, at least with small amounts of fluid, have not been rewarding. Tuberculous peritonitis, in absence of other complications or diseases, has been successfully treated with isoniazid and para-aminosalicylic acid. Eleven of our patients had histological evidence of tuberculosis outside the peritoneum or had positive sputum smears. Eight others had pleuropulmonary involvement, which showed a slow resolution on tuberculous chemotherapy. This high prevalence of documented or suggested tuberculosis of other organs indicates that tuberculous peritonitis is part of a disseminated tuberculosis. Since the pleuropulmonary lesions were of the "primary type," hematogenous dissemination from a primary pulmonary focus probably is the major mechanism of peritoneal involvement.