Tuberculous peritonitis

Tuberculous peritonitis is a chronic diffuse peritoneal infection caused by Mycobacterium tuberculosis. Based on the pathoanatomical characteristics of the disease, it can be classified into three types: exudative, adhesive, and caseous, with the former two types being more common. The main clinical manifestations include fever, night sweats, abdominal pain, ascites, periumbilical masses, and diarrhea, falling under the categories of "abdominal pain" and "abdominal mass" in traditional Chinese medicine. Although the prevalence of this disease in China has significantly decreased compared with the early period after liberation, it remains relatively common. It is often misdiagnosed or missed due to neglect, and attention should be paid to it. The disease can occur at any age, is more common in young and middle-aged adults, and is more frequent in women, especially those of childbearing age, possibly related to female genital tuberculosis. The male-to-female ratio is approximately 1:2. This disease is caused by infection of the peritoneum with Mycobacterium tuberculosis, and about 80% of patients have secondary infection from pulmonary tuberculosis or tuberculosis elsewhere in the body. The main route of Mycobacterium tuberculosis infection of the peritoneum is direct spread from intra-abdominal tuberculous lesions, with tuberculous mesenteric lymphadenitis, tubal tuberculosis, and intestinal tuberculosis being common primary lesions. A small number of cases are caused by hematogenous dissemination, and active pulmonary tuberculosis (primary infection or miliary pulmonary tuberculosis), joint, bone, and testicular tuberculosis may often be found, which may be accompanied by tuberculous polyserositis, tuberculous meningitis, etc. The key to treatment of this disease is to provide reasonable and sufficiently long courses of antituberculosis chemotherapy as early as possible, in order to achieve early recovery, avoid recurrence, and prevent complications. Attention to rest and nutrition to adjust the general condition and enhance disease resistance are important adjunctive therapeutic measures. Tuberculous peritonitis can achieve satisfactory results with rest and antituberculosis treatment, but in patients with severe complications, such as severe pulmonary tuberculosis or miliary tuberculosis complicated by tuberculous meningitis, the prognosis is poor. Early diagnosis and active treatment of tuberculosis of the lung, intestine, mesenteric lymph nodes, and fallopian tubes are important measures for the prevention of this disease.