Background: Peritoneal tuberculosis (PT) and peritoneal malignancy (PM) are the most frequent causes of exsudate ascitic fluid but the different diagnosis between the former and the latter is also difficult and elusive. Objective: To study the difference of clinical and laparoscopic features between PT and PM. Subjects and method: 76 patients with PT and 50 with PM were diagnosed by laparoscopy and peritoneal biopsy. Ascitic mycobacterium tuberculosis was detected by PCR analysis. Exsudate ascites was confirmed according to criteria of Light. Results and Conclusions: Average age of PT was younger than of PM (p < 0.001). The frequency of fever, pleural effusion in the patients with PT was higher than those in PM (p < 0.001 and 0.05). The anemia and abdominal tumefaction in those of PM was more frequent than in those of PT (p < 0.05 and 0.001). High protein ascitic fluid and numerous lymphocytes in the patients with PT was frequent than in those with PM (p < 0.05). Laparoscopic features: In those patients with PT the white "miliary nodules" or adhesions between abdominal wall was more frequent than in those with PM (p < 0,05) and in patients with PM omental thickening, tumor formation was more than in those with PT.
Peritonitis ; Tuberculous/pathology ; diagnosis ; Laparoscopy

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis. A total of 50% of the patients died within 12 months after being diagnosed. There are no obvious clinical symptoms in the early stage of EPS, which is easy to be missed. And there are few case reports of EPS in early stage. On December 22, 2018, a 70-year-old male patient undergoing peritoneal dialysis for 17 months, who was diagnosed as EPS, was admitted to the Department of Nephrology, the Third Xiangya Hospital, Central South University. The patient's peritoneal dialysis catheter was obstructed after peritonitis. The peritoneal dialysis fluid couldn't be drain in and out of the abdominal cavity. Therefore, the laparoscopy was performed to repair the catheter. The operation in progress showed that the peritoneum was slightly thickened and the ileocecal intestinal tube was closely adhered to the parietal peritoneum where the catheter was wrapped, indicating the early stage of EPS. Peritoneal relaxation was performed. The patient's catheter was normal after adhesiolysis. He underwent hemodialysis, nutritional supporting as well as peritoneal dialysis transition, etc. The peritonitis was controlled after 10 days and the peritoneal dialysis was resumed. After discharge from hospital, the patient took moxifloxacin for 2 more weeks. We followed up the patient for 6 months. The automated peritoneal dialysis is maintained, and everything remains normal. Clinicians need to improve understanding of EPS. Early diagnosis and laparoscopic adhesiolysis is helpful to continue peritoneal dialysis treatment.
Aged ; Early Diagnosis ; Humans ; Male ; Peritoneal Dialysis/adverse effects* ; Peritoneal Fibrosis/pathology* ; Peritoneum ; Peritonitis/pathology* ; Sclerosis/pathology*

Changes of abdominal organs in early paragonimiasis are described in dogs and cats. Experimental infection was induced by feeding 40-50 and 20-30 metacercariae of Paragonimus westermani to 15 dogs and 15 cats respectively. These animals were killed sequentially starting from 8 days to 120 days after infection. Complete autopsies were carried out in all animals and the tissues were examined microscopically with the main emphasis on changes of the liver and the diaphragm. A definite bout of acute diffuse fibrinoexudative peritonitis with ascites ranging from 5 to 20 ml was present in both dogs and cats at the time of 20 days after infection. This was also the period of the maximum liver damage and diaphragmatic injuries. The peritonitic changes became minimized after 45 days of infection. The liver changes were of two folds. The first one was characterized by numerous pin-point or linear tissue defects on the surface of the lobes, which were often covered with fibrin clots. Some of these defects were impacted by the larvae. These 'scratch' marks appeared to be of mechanical effect, and the margins were often banal without a significant inflammatory reaction. The scratch marks were no longer observed in animals examined after 45 days. The second was noted in the Kupffer cells of the liver. A large amount of hemosiderin pigment was noted in the Kupffer cells and became prominent by 20 days through 45 days. Hemosiderin-laden macrophages were found also in the spleens of these animals. Some animals in 30 days group showed the most Kupffer cells heavily loaded with hemosiderin. However, no associated degenerative changes were noted in these cells. The diaphragm was quite unique in early phase of infection in all animals examined. Numerous pinpoint perforative lesions could definitely be seen grossly, and some of these lesions included migrating larval worms inside the tunnels. These lesions were microscopically characterized by tract or tunnel formation with accompanying tissue reaction. The diaphragmatic changes were manifest by 20 days after infection. The tracts of tunnels appeared to have been made by pressure necrosis and surrounding edema, and subsequently were associated with a massive eosinophilic influx and myocytolysis. The eosinophilic abscess and multinucleated giant cells were often observed in the animals of the 30 days group. The diaphragmatic changes seemed to be repaired with or without fibrous scar formation which was occasionally seen in 45 days and later.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; diaphragm ; dog ; cat ; pathology ; peritonitis

PURPOSE: The prognosis following colonic perforation is generally regarded as worse than it is for upper gastrointestinal perforation. Moreover, the increasing incidence of colon cancer associated perforation is another reason for the present study of colonic perforation in the present study. We reviewed and analyzed various types of colonic perforations to determine which prognostic factors were still useful for the treatment of colonic perforation. METHODS: Thirty six patients (mean age, 51.5; 24 males) with generalized peritonitis secondary to a colonic perforation were studied retrospectively. All the patients had undergone an exploratory laparotomy. The severity of the clinical condition was recorded according to the APACHE III scoring system for all the patients when they were first seen. Mortality and morbidity were analyzed for possible prognostic factors, such as age, type of operation, association with malignancy, and APACHE-III score. RESULTS: Penetrating trauma was the leading cause of perforation (27.8%), and iatrogenic perforations accounted for 19.4% of the total. Among nontraumatic perforations, malignancy was the major pathology (25.0%). The sigmoid colon was the most frequent site of perforation. Types of surgical treatment varied according to the general conditions of the patients. In 22 patients, the operation was finished with primary closure alone. A colonic resection was performed in 14 patients, and a proximal diversion was performed in 19 patients (after either a resection or primary closure). Analysis of the various clinical variables showed that old age (>60), underlying malignancy, and the APACHE III score were significant prognostic factors for the surgical outcome. CONCLUSIONS: These results suggest that penetrating injuries are still the main cause of colonic perforation and that iatrogenic and malignancy-related perforations are increasing. Among other variables, old age, underlying malignancy and the APACHE III score are significant prognostic factors for the surgical outcome.
APACHE ; Colon* ; Colon, Sigmoid ; Colonic Neoplasms ; Humans ; Incidence ; Laparotomy ; Mortality ; Pathology ; Peritonitis* ; Prognosis ; Retrospective Studies

OBJECTIVETo improve the recognition and diagnosis of abdominal tuberculosis (TB) in children.

METHODThe data from 30 cases with abdominal TB hospitalized in Beijing Children's Hospital were analyzed retrospectively. The clinical significance of various tests was discussed respectively.

RESULTTwenty of the 30 cases were misdiagnosed as having upper respiratory tract infection, gastroenteritis, indigestion, and only 6 cases were diagnosed as pulmonary tuberculosis while the diagnosis of abdominal TB was made in just 4 cases at initial consultation. Twenty-one cases (70%) experienced the symptoms of abdominal pain or distension, diarrhoea, or constipation. The positive abdominal signs existed in all children including doughy sensation (9 cases), tenderness (8 cases), mass (4 cases), and hepatosplenomegaly (3 cases). Extraabdominal TB was found in 24 children, the positive PPD and abnormal ultrasonic image were seen in 93% and 100% of the cases, respectively. The exploratory laparotomy and colonoscopic biopsy confirmed the diagnosis in 3 and 2 cases, respectively. Twenty-four children received systematic treatment with good results.

CONCLUSIONThe abdominal TB in children which is easily misdiagnosed in it's early stage usually consisted of gastrointestinal symptoms and signs. The TB beyond the abdomen can be a clue for making correct diagnosis. PPD and ventral ultrasonic examination are important for ultimate clinical diagnosis while colonoscopy, and laparotomy can provide pathological evidence.

Abdominal Cavity ; pathology ; Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Peritonitis, Tuberculous ; diagnosis ; Retrospective Studies

Spontaneous bacterial peritonitis is one of the important complication of childhood nephrotic syndrome which occurs not infrequently but this complication in adults with nephrotic syndrome is ,however, very rare. The fact that ascites formation is more frequently seen in childhood nephrotic syndrome and that minimal change disease, the commonest pathology found in childhood is associated with impairment in both cellular and humoral immunities may be an explanation for the discrepancy. We have experienced two cases of spontaneous bacterial peritonitis complicated in adults with nephrotic syndrome. The age of patients is 23 and 68 years respectively. The serum IgG level of younger patient is markedly decreased (375 mg/dL) and that of elderly patient is lower normal limit (765 mg/dL). Peritonitis was complicated during relapse in the younger patient. Both of the patients were receiving steroid therapy before complicated by peritonitis. Both patients recovered from peritonitis by antibiotic therapy but, elderly patient died from nosocomial pneumonia.
Adult* ; Aged ; Ascites ; Humans ; Immunoglobulin G ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Pathology ; Peritonitis* ; Pneumonia ; Recurrence

Sclerosing encapsulating peritonitis (SEP) is a poorly understood and rarely documented cause of small bowel obstruction. Although recurrent peritonitis has been reported as the main contributory factor leading to secondary SEP, the pathogenesis of primary (idiopathic) SEP is still uncertain. A 40-year-old woman with a history of total abdominal hysterectomy due to gestational trophoblastic disease presented with progressive lower abdominal pain and abdominal distension. Ultrasonography and contrast-enhanced abdomen-pelvis computed tomography of the abdomen revealed encapsulation of the entire small bowel with a sclerotic capsule. At laparotomy, a fibrous thick capsule encasing small bowel loops was revealed. Extensive adhesiolysis and removal of the capsule from the bowel loops were performed. The patient recovered uneventfully; she was discharged without complications. SEP is a rare cause of small bowel obstruction. We treated a case of abdominal cocoon with intestinal partial obstruction in a woman with a history of abdominal hysterectomy due to gestational trophoblastic disease. Surgical treatment was effective and the patient recovered without complication.
Adult ; Female ; Humans ; Hysterectomy/*adverse effects ; Intestinal Obstruction/diagnosis/*etiology ; Intestine, Small/*pathology ; Peritonitis/diagnosis/*etiology/surgery ; Sclerosis/*pathology

No abstract available.
Abscess/*diagnosis ; Fibrosis ; Humans ; Intestine, Small/pathology/surgery ; Male ; Peritonitis/diagnosis ; Tomography, X-Ray Computed ; Urachus/*abnormalities ; Young Adult

OBJECTIVETo evaluate the computed tomography (CT) findings of peritoneal tuberculosis mimicking advanced ovarian carcinoma for better understanding of the CT manifestations and accurate preoperative diagnosis.

METHODSCT findings of 18 cases with tuberculous peritonitis clinically simulating advanced ovarian cancer but pathologically proved otherwise were retrospectively reviewed.

RESULTS1. Masses with solid and cystic structures were found in 6 cases and tumor-like flakes were found in 7 cases in the adnexal regions. The solid components and tumor-like flakes were moderately to markedly enhanced with dynamic CT scanning. 2. The peritoneum was smooth and slightly thickened in 10 cases; irregular thickening was seen in 4 cases, and patches of calcification in 3 cases. Thickened peritoneum with pronounced enhancement was noted in 7 cases. 3. Omentum with flake-like thickening was noted in 11 cases, coarse reticulate thickening in 2 cases and omental cakes in 2 cases. The margin of the thickened omentum with enhancement was ill-defined. 4. Nodular and stripe-like thickening of the mesentery was noted in 16 cases. 5. Ascites was present in all of the 18 cases, being encapsulated in 14 of them. 6. Lymphadenopathy was seen in 9 cases, all at located in the diaphragmatic levels. Enhancement of the lymph nodes was marked in 8 of the 8 patients examined. They appeared as ring-like (> 1 cm in diameter) or uniform (

CONCLUSIONCT examination combined with clinical manifestations helps differentiate tuberculous peritonitis from advanced ovarian cancer.

Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; Lymph Nodes ; pathology ; Middle Aged ; Ovarian Neoplasms ; diagnostic imaging ; pathology ; Peritonitis, Tuberculous ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

A case of intestinal angiocentric T/NK-cell lymphoma in a 58-year-old man is reported. The patient presented initially with panperitonitis because of perforation of sigmoid colon diverticulum. He underwent segmentectomy of involved bowel. Histologically, the intestinal wall showed diffuse infiltration of medium or large size lymphoma cells with angiocentric growth and necrosis. The lymphoma cells were CD56+, CD45RO+, CD3+, CD4-, CD8-, CD20-, and CD30- in paraffin sections with germline configuration of TCR-gamma gene, consistent with T/NK-cell lymphoma. Further staging revealed splenomegaly. Intestinal angiocentric T/NK cell lymphoma represents a distinct etiology of diverticulum with perforation.
Antigens, CD56/analysis ; Case Report ; Colon/pathology* ; Colonic Neoplasms/radiography ; Colonic Neoplasms/pathology* ; DNA, Neoplasm/analysis ; Diagnosis, Differential ; Diverticulitis, Colonic/radiography ; Diverticulitis, Colonic/pathology* ; Human ; Immunoglobulins, Heavy-Chain/genetics ; Killer Cells, Natural/pathology* ; Killer Cells, Natural/chemistry ; Lymphoma, T-Cell/pathology* ; Lymphoma, T-Cell/chemistry ; Male ; Middle Age ; Necrosis ; Peritonitis/radiography ; Peritonitis/pathology ; Receptors, Antigen, T-Cell/genetics ; Tomography, X-Ray Computed