Prevalence of tuberculous peritonitis in the North of Iraq and sociodemographic comparison with pulmonary tuberculosis

Objective:Tuberculosis continues to be an important health problem in the world.Despite the widespread impression that abdominal tuberculosis is rare today,the disease is still endemic in developing world and is reemerging in the West.The aim is to review our local experience with tuberculous peritonitis.Methods:Between January 2000 and December 2006,the case records of histologically documented tuberculous peritonitis (TBP) diagnosed and treated at the tuberculosis coordinating center in Erbil city,Iraq were reviewed.Comparisons were made with pulmonary tuberculosis patients regarding socio-demographic,clinical and laboratory findings.Results:Forty one cases of TBP were diagnosed during the study period.Their age range was 26-72 years(46±17),with a male:female ratio of 1.5;1.The median duration of symptoms before diagnosis was 6 weeks(range;10 days to 18 months.).Eleven patients(26.8%) had comorbid conditions and 6 patients (14.6%) had a history of positive contact with Tuberculosis(TB) case.Presenting symptoms were abdominal distension(70%),abdominal pain(65%),fever(68%),anorexia(65%) and weight loss(44%).Four patients had pulmonary symptoms;cough and/ dyspnoea(n= 2 ) and cough(n= 2).Chest X-ray changes consistent with pulmonary tuberulosis(PTB) were seen in 25%.Tuberculous peritonitis was diagnosed by laparoscopy (n=29) and laparotomy(n= 12).Adverse effects of TB drugs occurred in nearly 40%,consisting of hepatitis(n= 2),nausea/vomiting(n= 11),rash(n = 2) and encephalopathy(n = 1).Hemoglobin and serum albumin levels were significantly lower in tuberculous peritonitis(TBP)TBP patients(P =0.027 and 0. 003,respectively).There was a significantly greater occurrence of adverse effects(P【0.001) in TBP patients. No significant differences between TBP and PTB were demonstrated in regard to age and sex distribution, non-specific symptoms(fever,weight loss,and anorexia) and erythrocyte sedimentation rate.All were treated with standard regimens and responded to treatment.Conclusion:Tuberculous peritonitis is prevalent in our population.Therefore.TBP should be considered in patients presenting with abdominal symptoms and nonspecific constitutional symptoms,particularly in young patients.Laparoscopy and laparotomy with tissue biopsy was the specific diagnostic procedure.

Complicated hydatid cysts of the lung:surgical treatment in Kurdistan of Iraq

Objective:To review the problems encountered in surgical treatment of complicated pulmonary hydatid cysts and to evaluate the functional results in the surgery of complicated hydatid cysts.Methods:The medical records for 89 patients with complicated pulmonary hydatidosis were retrospectively investigated.The series consisted of 47 male and 42 female patients with a mean age of 32±8 years.Study performed during January 2000 to December 2007,all patients were treated surgically.Data related to surgical procedures performed,postoperative morbidity,hospitalization time,and cyst recurrence were collected from each individuals records,and the group findings were compared.Results:Among these cysts,58 were perforated,23 were infected,and 13 were cysts with pleural complications.Cystotomy plus capitonnage was the most frequently performed operative technique(n=43),followed by cystotomy plus closure of bronchial openings(n = 28),pericystectomy plus capitonnage(n=13),decortications(n=7),lobectomy and segmentectomy(n=3).The 11 cases with coexisting liver cysts were approached by right thoracophrenotomy.Postoperative complications developed in 12 patients(13.4%).Conclusion:Surgery is the primary mode of treatment for patients with pulmonary hydatid disease.Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases.This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis when it is indicated.