5.2. Intestinal, peritoneal, mesenterial lymphatic nodes tuberculosis


According to localization, differentiate intestinal, peritoneal, mesenterial tuberculosis. Such division is conditional, as at tuberculosis of abdominal cavity all groups of lymphatic nodes simultaneously exposed to infection. Thus, the symptoms of illness can be specific, connected with main localization of process. There are three forms of abdominal tuberculosis:

  1. primary;
  2. secondary;
  3. hyperplastic ileocaecal tuberculosis.

Clinically, the primary and secondary forms may be very similar.

The primary abdominal tuberculosis.

Abdominal tuberculosis in children can begin in three ways:

  1. from the milk of tuberculous cows that has been given to the child without previous boiling;
  2. from foods or liquids, spoons or fingers which carry human bacilli from an adult who is coughing up large numbers and does not take proper care about when or where he coughs;
  3. possibly, through blood spread to the peritoneum from a primary focus in the lung.

The primary tubercular lesion may be in the intestine and the nodes in the mesentery. As much as tuberculosis develops the nodes enlarge, can soften and may leak their tuberculous contents into the abdominal cavity. The result is free fluid (ascites) and a swollen abdomen. In other cases the nodes, instead of rupturing, stick together the coils of the intestines. This can cause pain and attacks of obstruction, which may even become complete. As the intestines become stuck to each other they may form masses which can be felt through the abdominal wall. Tuberculosis can also spread to the pelvis and in girls involve the fallopian tubes and the ovaries so that the patient later becomes sterile. Abdominal tuberculosis is a common cause of later infertility. It is necessary to distinguish swelling of the abdomen due to tuberculosis from other causes such as stretching of weak muscles in malnutrition or intestinal infestation.

Secondary abdominal tuberculosis.

In the secondary form patients with pulmonary tuberculosis swallow their sputum. The MBT in the sputum infect the wall of the intestine (usually the ileum) and ulceration and fistulae may occur as described above. Infection may spread into the abdominal cavity and cause ascites.

Hyperplastic ileocaecal tuberculosis is a rare form of the disease. It occurs in the region of the ileocaecal valve.

Peritoneal tuberculosis – disease is of expressed hematogenic dissemination, less often is complication of the lymphadenitis local forms, tuberculosis of other organs of abdominal cavity and pelvis. The clinical symptoms are not expressed, intoxication is absent. Further at occurrence of exudates – the signs of intoxication, dyspepsia, loss of body weight appear. At adhesive form – signs of intoxication, dyspepsia, development of partial intestine impassability are present. Nodal-tumor form proceeds with expressed intoxication, formation of conglomerates in abdominal cavity from fused loops of intestines, omentum, and encapsulated exudates with symptoms partial intestines impassability.

Tuberculosis of mesenterial lymphatic nodes (mesoadenitis) – tuberculosis of mesenterial lymphatic nodes in infiltrative phase characterized by inflammation reaction in mesenterial lymphatic nodes without expressed inflammation around focuses and symptoms of intoxication. In caseouse-necrotic phase increase of lymphatic nodes, perifocal reaction, involving peritoneum in process.

The general clinical features of intestinal, peritoneal, mesenterial tuberculosis.

  1. Intoxication: loss of weight, loss of appetite, fever; night sweats; diarrhea; loss of menstrual periods very common.
  2. Abdominal pain (often vague).
  3. Abdominal mass or masses formation (often rather soft to feel).
  4. There is often also fluid in the abdomen (ascites). Sometimes there is so much fluid that you cannot feel any mass, so that the main sign is ascites.
  5. Attacks of intestinal obstruction with acute pain and distension of the abdomen.
  6. Cough and sputum if the bowel disease is caused by swallowing the sputum from pulmonary tuberculosis (of secondary form).

In hyperplastic ileocaecal, tuberculosis there may be pain and a mass to be felt in the right lower abdomen. There may be no signs elsewhere. This can be confused with a cancer of the bowel.

The following symptoms attract attention to abdominal tuberculosis:losing weight, has fever, and, and has vague abdominal pain. Be even more suspicious if there is an abdominal mass or fluid in the abdomen.

You will usually have to make the diagnosis on clinical grounds. But sometimes additional help may be obtained from:

  1. X-ray examination of the bowel.
  2. Biopsy of lymph node or peritoneum at operation or laparoscopy (insertion of lighted tube into the abdomen).
  3. Culture of material from aspiration of liquid from the abdominal cavity or from pus from sinuses.


This is a fistula or sinus in the region of the anus. It may complicate abdominal tuberculosis, but may be the only obvious lesion. In high prevalence countries tuberculosis is the commonest cause. It is important to remember that it can occur at ulcerative colitis, Crohn’s disease and other conditions. Fistula-in-ano when due to tuberculosis, it improves rapidly with chemotherapy.

Chemotherapy is usually highly effective. Even large masses fade completely away. Occasionally healed disease leaves adhesions between loops of intestine, or scarring. These sometimes later cause mechanical obstruction of the bowel which may need surgery. If there is a large amount of fluid you may have to aspirate it by means of paracentesis of the abdominal cavity.

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