Tuberculous enteritis and peritonitis. Report of 36 general hospital cases

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Abstract
Of 36 patients with gastrointestinal tuberculosis, 21 had peritonitis, 11 had enteritis and 4 had both. Diagnostic criteria were caseating granulomas or positive smear or culture from an abdominal specimen, culture-proved pulmonary tuberculosis plus ascitic fluid containing protein, > 3.0 g/dl, and more than 50% lymphocytes, or granulomatous enteritis on X-ray studies that resolved with anti-tuberculous therapy. In only 4 of 15 patients with enteritis was the disease confined to the ileocecal region. Fourteen patients (40%) had complications: bowel obstruction in 10, perforation in 6 and fistula in 5. Of these, 5 died. Two perforations and 1 death followed paracentesis and needle biopsy. Tuberculous peritonitis can be diagnosed without biopsy when lymphocytic exudative ascites responds to anti-tuberculous chemotherapy given for concurrent culture-proved pulmonary tuberculosis. Patients with pulmonary tuberculosis and persistent abdominal complaints who have granulomatous enteritis probably have tuberculous enteritis. Surgery is reserved for bowel obstruction, perforation, fistula or a mass that does not resolve with drug therapy.