Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ² test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ²=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ²=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ²=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.
Female ; Male ; Humans ; Empyema, Tuberculous/surgery* ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Drainage ; Blood Loss, Surgical ; Tuberculosis, Multidrug-Resistant/surgery*

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.
Male ; Female ; Humans ; Abscess/complications* ; Empyema, Pleural/etiology* ; Empyema, Tuberculous/complications* ; Retrospective Studies ; Thoracic Wall ; Debridement/adverse effects* ; China ; Chest Tubes/adverse effects* ; Tuberculosis/complications* ; Thoracic Surgery, Video-Assisted ; Drainage

Objective: To examine the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) decortication in patients presenting with stage Ⅲ tuberculous empyema. Methods: From August 2017 to July 2020, 158 patients of stage Ⅲ tuberculous empyema underwent uniportal VATS decortication with partial rib resection and customized periosteal stripper in Department of Thoracic Surgery, Shanghai Pulmonary Hospital. There were 127 males and 31 females, aged (M(IQR)) 32(28) years (range:14 to 78 years). Follow-up was performed in the outpatient clinic or via social communication applications, at monthly thereafter. If there was no air leak and chest tube drainage was less than 50 ml/day, a chest CT was performed. If the lung was fully re-expanded, chest tubes were removed. All patients received a follow-up chest CT 3 to 6 months following their initial operations which was compared to their preoperative imaging. Results: There was one conversion to open thoracotomy. The operative time was 2.75 (2.50) hours (range: 1.5 to 7.0 hours), and median blood loss was 100 (500) ml (range: 50 to 2 000 ml). There were no perioperative mortalities. There were no major complications except 1 case of redo-VATS for hemostasis due to excessive drainage and 1 case of incision infection, The incidence of prolonged air leaks (>5 days) was 80.3%(126/157). The postoperative hospital stay was 5.00 (2.25) days (range: 2 to 15 days). All patients were discharged with 2 chest tubes, and the median duration drainage was 21.00 (22.50) days (range: 3 to 77 days). Follow-up was completed in all patients over a duration of 20 (14) months (range: 12 to 44 months). At follow-up, 149 patients(94.9%) recovered to grade Ⅰ level, 7 patients to grade Ⅱ level, and 1 patient to grade Ⅲ level. Conclusion: Uniportal VATS decortication involving partial rib resection and a customized periosteal stripper is safe and effective for patients with stage Ⅲ tuberculous empyema.
Aged ; China ; Empyema, Tuberculous/surgery* ; Female ; Humans ; Male ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy

Tuberculous peritonitis(TBP)is currently one of the common manifestations of extrapulmonary tuberculosis.Due to the atypical clinical features,diverse types of diseases to be distinguished,and limited detection methods,TBP is difficult to be diagnosed and the fatality caused by delayed diagnosis increases significantly.We studied the current research status of TBP and found that T cells spot test,abdominal CT,and laparoscopic biopsy were of high diagnostic value for TBP.However,the application of ascites Xpert-MTB/RIF-ultra assay,ascites ADA,and whole-body positron emission tomography/computed tomography remained to be studied.Serum CA125 helps to judge the efficacy of anti-tuberculosis treatment.
Ascites ; Biopsy ; Humans ; Mycobacterium tuberculosis ; Peritonitis, Tuberculous/diagnosis* ; Sensitivity and Specificity ; Tuberculosis/diagnosis*

Perihepatic capsulitis is associated with various diseases, such as Fitz-Hugh-Curtis syndrome, systemic lupus erythematosus, perforated cholecystitis, perforated hepatic abscess, and tuberculous peritonitis. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and is characterized by the widespread millet-like hematogenous dissemination of Mycobacterium tuberculosis. We describe a 24-year-old virgin patient presenting with right upper quadrant and costovertebral angle pain. Diffuse perihepatic capsular enhancement was observed in abdominal computed tomography scans. Chest radiography showed miliary tuberculosis, and a polymerase chain reaction hybridization assay of sputum revealed the presence of M. tuberculosis. Symptoms improved after administering anti-tuberculosis medications. This report describes a rare case of miliary tuberculosis accompanying perihepatitis.
Cholecystitis ; Humans ; Liver Abscess ; Lupus Erythematosus, Systemic ; Mycobacterium tuberculosis ; Peritonitis, Tuberculous ; Polymerase Chain Reaction ; Radiography ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Miliary ; Young Adult

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.
Aged ; Ascites ; Ascitic Fluid ; Biomarkers ; Biopsy ; CA-125 Antigen ; Carcinoma ; Diagnosis, Differential ; Dyspepsia ; Hand ; Humans ; Laparoscopy ; Laparotomy ; Male ; Mesothelioma ; Methods ; Peritoneum ; Peritonitis, Tuberculous ; Sensation ; Tomography, X-Ray Computed

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.
Aged ; Ascites ; Ascitic Fluid ; Biomarkers ; Biopsy ; CA-125 Antigen ; Carcinoma ; Diagnosis, Differential ; Dyspepsia ; Hand ; Humans ; Laparoscopy ; Laparotomy ; Male ; Mesothelioma ; Methods ; Peritoneum ; Peritonitis, Tuberculous ; Sensation ; Tomography, X-Ray Computed

PURPOSE: We report a case of spontaneous recovery of an iris cyst with only tuberculosis medication and conservative eye drops when uveitis and angle closure occurred because of a cyst in a patient with peritoneal tuberculosis. CASE SUMMARY: A 49-year-old female who was diagnosed with iritis and treated with steroid eye drops visited our clinic because of decreased visual acuity 1 month prior. There were anterior chamber inflammation cells and an iris cyst completely obstructing the anterior chamber at 12 o'clock. At the time, the patient had been diagnosed with peritoneal tuberculosis in the Department of Internal Medicine and Gynecology and had been treated with surgery and medication. The patient had no past history of glaucoma, but when the iris cyst developed, the intraocular pressure increased to 29 mmHg and anterior inflammatory cells were seen in the range of +1 to +2. The primary lesion of tuberculosis improved and the iris cyst disappeared with treatments involving medication for tuberculosis, steroid eye drops, and glaucoma eye drops, without invasive treatments such as alcohol curettage, laser treatment, or cyst resection. CONCLUSIONS: If an iris cyst is a new lesion of the eye, it is necessary to identify the pattern and cause of the iris cyst first, and if a secondary benign iris cyst is suspected, the primary treatment of the causative disease is necessary rather than prompt invasive treatment.
Anterior Chamber ; Curettage ; Female ; Glaucoma ; Gynecology ; Humans ; Inflammation ; Internal Medicine ; Intraocular Pressure ; Iris ; Iritis ; Middle Aged ; Ophthalmic Solutions ; Peritonitis, Tuberculous ; Tuberculosis ; Uveitis ; Visual Acuity

The peritoneum is one of the common extrapulmonary sites of tuberculosis infection. Patients with underlying end-stage renal or liver disease are frequently complicated by tuberculous peritonitis; however, the diagnosis of the tuberculous peritonitis is difficult due to its insidious nature, well as its variability in presentation and limitation of available diagnostic tests. Once diagnosed, the preferred treatment is usually antituberculous therapy in uncomplicated cases. However, surgical treatment may also be required for complicated cases, such as small bowel obstruction or perforation. An 85-year-old woman was referred our hospital for abdominal pain with ileus. Despite medical therapy, prolonged ileus and progression to sepsis were shown, she underwent surgery to confirm the diagnosis and relief of mechanical ileus. Intraoperative peritoneal biopsy and macroscopic findings confirmed tuberculous peritonitis. Therefore, physicians should consider the possibility of tuberculous peritonitis in patients with unexplained small bowel obstruction.
Abdominal Pain ; Aged, 80 and over ; Biopsy ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Humans ; Ileus ; Intestinal Obstruction ; Laparoscopy ; Liver Diseases ; Peritoneum ; Peritonitis, Tuberculous* ; Sepsis ; Tuberculosis

Tuberculous peritonitis in pregnancy is a rare form of extrapulmonary tuberculosis that is not easily diagnosed. The clinical presentations of tuberculous peritonitis are usually non-specific and mimic those of other diseases, such as ovarian malignancy or chronic liver disease, and this non-specificity can cause diagnostic delays and complications. The authors report the case of a 31-year-old primigravida woman who presented with uncontrolled fever, dyspnea, elevated liver enzymes, and mild abdominal distension at 13+2 weeks of gestation. At 14+2 weeks, a therapeutic abortion was conducted and tuberculous peritonitis was confirmed by laparoscopic excisional biopsy of peritoneal nodules and histopathologic examination. The patient recovered on antituberculosis therapy and abdomen and chest follow up radiographic findings have confirmed improvement.
Abdomen ; Abortion, Therapeutic ; Adult ; Biopsy ; Dyspnea ; Female ; Fever ; Follow-Up Studies ; Humans ; Liver ; Liver Diseases ; Peritonitis ; Peritonitis, Tuberculous* ; Pregnancy ; Pregnancy Trimester, First* ; Pregnancy* ; Thorax ; Tuberculosis