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Tuberculous Peritonitis

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101. Primary gastric tuberculosis presenting as gastric outlet obstruction: a case report and review of the literature (PubMed)

, cryptitis and multiple lymphoid follicles, no malignancy seen. Sonographic test showed hypodense pyloric mass, enlarged para-aortic and mesenteric lymph nodes and mild pelvic ascites. A computed tomography scan of the abdomen and pelvis showed antral hypodense lesions multiple mesenteric lymphadenopathies peritoneal thickening and ascites. Chest X-ray was normal. Intra-operative findings were dilated stomach and pylorus mass with multiple mesenteric lymph nodes, peritoneal and omental seedlings all over (...) with small nodules on the surface of the liver, gastro-jejunostomy was done. Histopathology confirmed the diagnosis of abdominal tuberculosis. Postoperative event was uneventful. Patient received anti-tuberculous.Here we presented an unusual case of gastric outlet obstruction due to primary gastric tuberculosis, patient underwent surgery to relief his symptoms and received anti-tuberculous.

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2015 Journal of medical case reports

102. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis (PubMed)

Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations (...) of the small bowel extending 10-15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6-8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before.

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2015 Case reports in surgery

103. Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach (PubMed)

was exposed via an anterior midline retroperitoneal approach. After radical debridement, two parallel tricortical iliac crest bone allografts were placed to reconstruct the anterior column, and then anterior fixation was performed.The mean follow-up period was 34 months (range, 24-91 months), during which no obvious loss of correction was observed. No case experienced recurrence, tuberculous peritonitis, erectile dysfunction, or retrograde ejaculation.The midline retroperitoneal approach provides direct

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2015 Journal of orthopaedic surgery and research

105. Role of transgastric natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin (with videos). (PubMed)

transgastric NOTES.Characteristic of ascites cases, conditions of the abdominal cavity, diagnostic accuracy, adverse events, and follow-up time.Transgastric NOTES was performed successfully in 78 patients with ascites of unknown origin, and 72 cases (92.3%) were clearly diagnosed. They included malignant tumors (39 cases), tuberculous peritonitis (28 cases), chronic hepatic inflammation (3 cases), necrotizing lymphadenitis (1 case), and eosinophilic serositis of the small intestine (1 case). In addition (...) , there were 6 nondiagnostic cases, and no severe adverse events were found.Nonrandomized control analysis.Transgastric NOTES in combination with biopsy can elucidate the causes of ascites of unknown origin in the majority of cases. Therefore, it is a feasible and effective approach to access the peritoneal cavity and also a valuable modality to detect the cause of diseases with ascites of unknown origin.Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights

2014 Gastrointestinal endoscopy

106. MAIT Cell Function is Modulated by PD-1 Signaling in Patients with Active Tuberculosis. (PubMed)

with pulmonary TB, tuberculous pleurisy, and tuberculous peritonitis by flow cytometry. The functions of MAIT cells were compared between patients with active TB and healthy control subjects.The frequency of MAIT cells was significantly reduced both in peripheral blood from patients with active pulmonary TB (P < 0.0001) and in tuberculous pleural effusions compared with healthy control subjects but not in ascitic fluids from patients with tuberculous peritonitis. A comparison of bacillus Calmette-Guérin (BCG

2014 American Journal of Respiratory and Critical Care Medicine

107. Epididymal Tuberculosis (Overview)

of infection , whereas adults seem to develop tuberculous epididymoorchitis caused by direct spread from the urinary tract. [ ] The formation of a draining sinus is uncommon in developed countries, but epididymal induration and beading of the vas are common. Involvement of the testis is usually due to direct extension. Infertility may result from bilateral vasal obstruction. Nodular beading of the vas is a characteristic physical finding, and orchitis and the resulting testicular swelling can be difficult (...) . Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract secondary to mycobacteria exposure during intercourse. The penile ulcer may cause cavernositis that extends to the urethra. This form of TB may involve the uterus and fallopian tubes, causing strictures. Consider malignancy if genital ulcers are present. Acute urethritis manifests as mycobacterial discharge and often results in chronic stricture formation. Next: Causative

2014 eMedicine.com

108. Atypical Mycobacterial Diseases (Follow-up)

, Rengasamy G, Madasamy B, Kulanthaivelu A, Subramanian G. Subcutaneous aspergillosis with coexisting atypical mycobacterial infection. Indian J Pathol Microbiol . 2010 Apr-Jun. 53(2):359-60. . Seidl A, Lindeque B. Large joint osteoarticular infection caused by Mycobacterium arupense. Orthopedics . 2014 Sep. 37(9):e848-50. . Hauch A, Ory B, Paramesh A. Atypical mycobacterial infections of peritoneal dialysis catheter exit sites - a louisiana issue. J La State Med Soc . 2014 Sep-Oct. 166(5):213-6 (...) . Sporotrichoid dermatosis caused by Mycobacterium abscessus from a public bath. J Dermatol . 2000 Apr. 27(4):264-8. . Edeer Karaca N, Boisson-Dupuis S, et al. Granulomatous skin lesions, severe scrotal and lower limb edema due to mycobacterial infections in a child with complete IFN-? receptor-1 deficiency. Immunotherapy . 2012 Nov. 4(11):1121-7. . Pai HH, Chen WC, Peng CF. Isolation of non-tuberculous mycobacteria from hospital cockroaches (Periplaneta americana). J Hosp Infect . 2003 Mar. 53(3):224-8

2014 eMedicine.com

109. Tuberculosis of the Genitourinary System (Diagnosis)

of hematologic spread of infection , whereas adults seem to develop tuberculous epididymoorchitis caused by direct spread from the urinary tract. [ ] The formation of a draining sinus is uncommon in developed countries, but epididymal induration and beading of the vas are common. Involvement of the testis is usually due to direct extension. Infertility may result from bilateral vasal obstruction. Nodular beading of the vas is a characteristic physical finding, and orchitis and the resulting testicular (...) is secondary to genital TB. Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract secondary to mycobacteria exposure during intercourse. The penile ulcer may cause cavernositis that extends to the urethra. This form of TB may involve the uterus and fallopian tubes, causing strictures. Consider malignancy if genital ulcers are present. Acute urethritis manifests as mycobacterial discharge and often results in chronic stricture

2014 eMedicine.com

110. Trematode Infection (Diagnosis)

metacercariae. This is the infective stage for the mammalian host (5). Human infection with Paragonimus westermani occurs by eating inadequately cooked or pickled crab or crayfish that harbor metacercariae of the parasite (6). The metacercariae excyst in the duodenum (7), penetrate through the intestinal wall into the peritoneal cavity, and then through the abdominal wall and diaphragm into the lungs, where they become encapsulated and develop into adults (8) (7.5-12 mm X 4-6 mm). The worms can also reach (...) cercariae. Table 3. Comparative Features of Major Human Schistosoma Species S haematobium S mansoni S japonicum Adult Body surface of male Finely tuberculate Grossly tuberculate Nontuberculate (smooth) Testes 4-6, in a cluster 6-9, in a cluster 7, in a linear series Position of ovary Posterior to middle of body Anterior to middle of body Posterior to middle of body Number of eggs in uterus 20-30 1-4 50-300 Egg Size and shape 110-170 μm long 40-70 μm wide Terminal spine 114-175 μm long 45-68 μm wide

2014 eMedicine.com

111. Tuberculosis of the Genitourinary System (Overview)

of hematologic spread of infection , whereas adults seem to develop tuberculous epididymoorchitis caused by direct spread from the urinary tract. [ ] The formation of a draining sinus is uncommon in developed countries, but epididymal induration and beading of the vas are common. Involvement of the testis is usually due to direct extension. Infertility may result from bilateral vasal obstruction. Nodular beading of the vas is a characteristic physical finding, and orchitis and the resulting testicular (...) is secondary to genital TB. Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract secondary to mycobacteria exposure during intercourse. The penile ulcer may cause cavernositis that extends to the urethra. This form of TB may involve the uterus and fallopian tubes, causing strictures. Consider malignancy if genital ulcers are present. Acute urethritis manifests as mycobacterial discharge and often results in chronic stricture

2014 eMedicine.com

112. Trematode Infection (Overview)

metacercariae. This is the infective stage for the mammalian host (5). Human infection with Paragonimus westermani occurs by eating inadequately cooked or pickled crab or crayfish that harbor metacercariae of the parasite (6). The metacercariae excyst in the duodenum (7), penetrate through the intestinal wall into the peritoneal cavity, and then through the abdominal wall and diaphragm into the lungs, where they become encapsulated and develop into adults (8) (7.5-12 mm X 4-6 mm). The worms can also reach (...) cercariae. Table 3. Comparative Features of Major Human Schistosoma Species S haematobium S mansoni S japonicum Adult Body surface of male Finely tuberculate Grossly tuberculate Nontuberculate (smooth) Testes 4-6, in a cluster 6-9, in a cluster 7, in a linear series Position of ovary Posterior to middle of body Anterior to middle of body Posterior to middle of body Number of eggs in uterus 20-30 1-4 50-300 Egg Size and shape 110-170 μm long 40-70 μm wide Terminal spine 114-175 μm long 45-68 μm wide

2014 eMedicine.com

113. Atypical Mycobacterial Diseases (Overview)

, Rengasamy G, Madasamy B, Kulanthaivelu A, Subramanian G. Subcutaneous aspergillosis with coexisting atypical mycobacterial infection. Indian J Pathol Microbiol . 2010 Apr-Jun. 53(2):359-60. . Seidl A, Lindeque B. Large joint osteoarticular infection caused by Mycobacterium arupense. Orthopedics . 2014 Sep. 37(9):e848-50. . Hauch A, Ory B, Paramesh A. Atypical mycobacterial infections of peritoneal dialysis catheter exit sites - a louisiana issue. J La State Med Soc . 2014 Sep-Oct. 166(5):213-6 (...) . Sporotrichoid dermatosis caused by Mycobacterium abscessus from a public bath. J Dermatol . 2000 Apr. 27(4):264-8. . Edeer Karaca N, Boisson-Dupuis S, et al. Granulomatous skin lesions, severe scrotal and lower limb edema due to mycobacterial infections in a child with complete IFN-? receptor-1 deficiency. Immunotherapy . 2012 Nov. 4(11):1121-7. . Pai HH, Chen WC, Peng CF. Isolation of non-tuberculous mycobacteria from hospital cockroaches (Periplaneta americana). J Hosp Infect . 2003 Mar. 53(3):224-8

2014 eMedicine.com

114. Abdominal Hernias (Treatment)

hernia is generally safe, failure to reduce is not infrequent and mandates prompt exploration. Signs of inflammation or obstruction should rule out attempts at reduction. Difficult reduction should promptly be followed by repair. Unintentional reduction of the intestine with vascular compromise leads to perforation and peritonitis with high morbidity and mortality. En masse reduction after vigorous attempts at reducing a hernia with a small fibrous neck results in ongoing compromise of the entrapped (...) (particularly the fallopian tube and ovary) may not be reducible into the peritoneum. The walls must then be inspected for a sliding component. To repair a sliding hernia, the sac is ligated distal to the fallopian tube and divided. The proximal sac is ligated and then invaginated into the peritoneal cavity. A purse-string suture inside the opened hernia sac may be used to aid in visualization during sac closure. The internal ring is closed with sutures from the transversalis fascia to the iliopubic tract

2014 eMedicine Surgery

115. Vertebral Fracture (Overview)

in hemorrhagic shock. A bedside ultrasound evaluation is a noninvasive screen for free fluid in the peritoneum. The more invasive peritoneal tap and lavage is the classic method of assessment for free fluid. Both types of shock require aggressive fluid and hemodynamic resuscitation. Spinal shock refers to the temporary loss of spinal reflex activity that occurs below a total or near-total spinal cord injury. It initially results in hyporeflexia and flaccid paralysis. With time, the descending inhibitory (...) -68. . Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord . 2001 Aug. 39(8):429-36. . Larson JL. Injuries to the spine. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed . New York, NY: McGraw-Hill. 2000: 1792-1800. Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop

2014 eMedicine Surgery

116. Abdominal Hernias (Follow-up)

hernia is generally safe, failure to reduce is not infrequent and mandates prompt exploration. Signs of inflammation or obstruction should rule out attempts at reduction. Difficult reduction should promptly be followed by repair. Unintentional reduction of the intestine with vascular compromise leads to perforation and peritonitis with high morbidity and mortality. En masse reduction after vigorous attempts at reducing a hernia with a small fibrous neck results in ongoing compromise of the entrapped (...) (particularly the fallopian tube and ovary) may not be reducible into the peritoneum. The walls must then be inspected for a sliding component. To repair a sliding hernia, the sac is ligated distal to the fallopian tube and divided. The proximal sac is ligated and then invaginated into the peritoneal cavity. A purse-string suture inside the opened hernia sac may be used to aid in visualization during sac closure. The internal ring is closed with sutures from the transversalis fascia to the iliopubic tract

2014 eMedicine Surgery

117. Vertebral Fracture (Diagnosis)

in hemorrhagic shock. A bedside ultrasound evaluation is a noninvasive screen for free fluid in the peritoneum. The more invasive peritoneal tap and lavage is the classic method of assessment for free fluid. Both types of shock require aggressive fluid and hemodynamic resuscitation. Spinal shock refers to the temporary loss of spinal reflex activity that occurs below a total or near-total spinal cord injury. It initially results in hyporeflexia and flaccid paralysis. With time, the descending inhibitory (...) -68. . Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord . 2001 Aug. 39(8):429-36. . Larson JL. Injuries to the spine. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed . New York, NY: McGraw-Hill. 2000: 1792-1800. Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop

2014 eMedicine Surgery

118. Tuberculosis of the Genitourinary System (Follow-up)

of hematologic spread of infection , whereas adults seem to develop tuberculous epididymoorchitis caused by direct spread from the urinary tract. [ ] The formation of a draining sinus is uncommon in developed countries, but epididymal induration and beading of the vas are common. Involvement of the testis is usually due to direct extension. Infertility may result from bilateral vasal obstruction. Nodular beading of the vas is a characteristic physical finding, and orchitis and the resulting testicular (...) is secondary to genital TB. Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract secondary to mycobacteria exposure during intercourse. The penile ulcer may cause cavernositis that extends to the urethra. This form of TB may involve the uterus and fallopian tubes, causing strictures. Consider malignancy if genital ulcers are present. Acute urethritis manifests as mycobacterial discharge and often results in chronic stricture

2014 eMedicine.com

119. Cirrhosis (Follow-up)

America and Europe are cirrhosis, neoplasm, congestive heart failure, and tuberculous peritonitis. In the past, ascites was classified as being a transudate or an exudate. In transudative ascites, fluid was said to cross the liver capsule because of an imbalance in Starling forces. In general, ascites protein would be less than 2.5 g/dL in this form of ascites. A classic cause of transudative ascites would be portal hypertension secondary to cirrhosis and congestive heart failure. In exudative ascites (...) , fluid was said to weep from an inflamed or tumor-laden peritoneum. In general, ascites protein in exudative ascites would be greater than 2.5 g/dL. Causes of the condition would include peritoneal carcinomatosis and tuberculous peritonitis. Nonperitoneal causes Attributing ascites to diseases of nonperitoneal or peritoneal origin is more useful. Thanks to the work of Bruce Runyon, the serum-ascites albumin gradient (SAAG) has come into common clinical use for differentiating these conditions

2014 eMedicine.com

120. Mycobacterium Chelonae (Diagnosis)

intervention involving injectable foreign materials, artificial prostheses, and implantable devices (eg, pacemakers, prosthetic valves) are at risk. [ ] Surgical site infections have ranged from sternal wound infections associated with the bone wax to plastic and reconstructive surgical infections linked to contaminated water or marking solution. [ , ] These infections have been associated with acupuncture and mesotherapy in South America. [ ] M chelonae has caused peritonitis and dialysis catheter (...) infections in peritoneal dialysis patients. [ ] It causes intravascular catheter infections of all types and is particularly common in the immunocompromised patient. The eye is the second most common site of M chelonae infection. The organism is known to cause , canaliculitis, conjunctivitis, , , and keratitis. [ ] Risk factors for infection include both accidental and surgical trauma, (LASIK), penetrating keratoplasty (PK), and all procedures involving retained biomaterial. [ ] Additional risk factors

2014 eMedicine.com

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