CLINICAL DIAGNOSIS OF ABDOMINAL TUBERCULOSIS
CLINICAL DIAGNOSIS OF ABDOMINAL TUBERCULOSIS
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DOI：
10.1002/bjs.1800631213
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发表时间：
1976-01-01
影响因子：
9.6
通讯作者：
SHUKLA, HS
中科院分区：
文献类型：
--
作者：
DAS, P;SHUKLA, HS
回顾了阿拉哈巴德Swaroop拉尼内赫里医院在过去7年中收治的182例腹部结核病例，其中只有50%的病例的临床诊断正确。大约一半的病例表现为慢性或急性慢性肠梗阻。其余患者有隐痛、腹部压痛、全身症状或腹部肿块。腹泻不常见，瘘管形成罕见。慢性阻塞性病变不仅见于肠病变，也见于慢性粟粒性腹膜炎和结核性肠系膜淋巴结炎。同样，肿块不仅存在于肥大性肠结核，也存在于慢性粟粒性腹膜炎和结核性肠系膜淋巴结炎。在放射学检查假阳性的特点，如液体水平，肠扩张，甚至'字符串'的迹象。肝脏和子宫内膜活检仅在极少数病例中呈阳性。腹膜活检有相当大的帮助，在88%的腹水病例和42.1%的非腹水病例中阳性。在右髂窝小切口后获得的开放性腹膜活检被认为是诊断腹部结核最有用的检查。腹水蛋白含量≥ 2.5 g和淋巴细胞计数> 100/mm 3是诊断标准，但1例腹水淋巴细胞计数> 10/mm 3。
One hundred and eighty‐two cases of abdominal tuberculosis admitted to Swaroop Rani Nehri (SRN) Hospital, Allahabad, in the past 7 years have been reviewed.The clinical diagnosis of abdominal tuberculosis was made correctly only in 50 per cent of cases. About half the cases presented with chronic or acute on chronic intestinal Obstruction. The remaining patients had vague pains, tender abdomen, constitutional symptoms or a mass in the abdomen. Diarrhoea was not frequent and fistula formation was rare. A chronic obstructive type of lesion was found not only in cases with a bowel lesion but also in patients with chronic miliary peritonitis and tuberculous mesenteric adenitis. Similarly, a lump was present not only in hypertrophic bowel tuberculosis but also in chronic miliary peritonitis and tuberculous mesenteric adenitis. On radiological examination false positive features such as fluid levels, bowel dilatation or even the ‘string’ sign were encountered. Liver and endometrial biopsies were positive in only a very few cases. Peritoneal biopsy was of considerable help, being positive in 88 per cent of ascitic cases and in 42.1 per cent of non‐ascitic cases.Open peritoneal biopsy obtained after making a small incision in the right iliac fossa was found to be the most useful investigation in the diagnosis of abdominal tuberculosis. An ascitic fluid protein content of 2.5 g or more and a predominantly lymphocytic count of over 100/mm3are diagnostic, but a cell count of 10/mm3was recorded in one tuberculous case.