Skip to main content
SpringerLink
Log in

Therapie der abdominellen Tuberkulose

Hintergrund, Diagnostik und Therapie einer globalen Problematik

Treatment of abdominal tuberculosis

Background, diagnostics and treatment of a global problem

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Tuberkulose (TB) ist eine der häufigsten Todesursachen der Welt. Insbesondere Immunsupprimierte (HIV) sind gefährdet. Durch Migration aus Endemiegebieten kann sie vermehrt auch in Zentraleuropa angetroffen werden.

Ziel der Arbeit

Die Arbeit gibt einen Überblick über Hintergrundinformationen, Nachweismethoden und Aufgaben der Chirurgie bei abdomineller Manifestation einer systemischen Infektion.

Material und Methoden

Initial wurde eine PubMed-Recherche mit folgenden Schlüsselwörtern durchgeführt: abdominelle Tuberkulose, Inzidenz, Symptome, Diagnostik, Therapie, Chirurgie.

Ergebnisse

Der Nachweis der TB kann bei abdomineller Manifestation als transkutane Probenentnahme erfolgen. Es empfiehlt sich jedoch die Laparoskopie aufgrund der besseren Nachweisquote und Sicherheit sowie zum Ausschluss von Differenzialdiagnosen (Peritonealkarzinose, Lymphome). Die primäre Therapie ist medikamentös. Ein „akutes Abdomen“ kann in bis zu 30 % der Fälle auftreten. Komplikationen wie Perforationen oder Strikturen bedürfen einer chirurgischen Therapie.

Diskussion

Obwohl die Prävalenz der Erkrankung regredient ist, versterben jährlich über 1 Mio. Menschen an TB. Da eine abdominelle Manifestation mit uneindeutiger Klinik einhergehen kann, ist die Diagnosefindung mitunter erschwert. Ein multidisziplinärer Ansatz ermöglicht eine schnelle und effiziente Diagnostik und Therapie.

Abstract

Background

Tuberculosis (TB) is among the 10 leading causes of global deaths and is a special threat to immunocompromised patients with human immunodeficiency virus (HIV). Due to migration from endemic areas cases in central Europe can also increase.

Objective

This article gives an overview of background information, detection methods, treatment and the role of surgery in abdominal manifestation of a systemic infection.

Material and methods

A PubMed search was carried out using the following keywords: abdominal TB, incidence, symptoms, diagnostics, treatment and surgery.

Results

The detection of TB in cases of abdominal manifestation can be carried out via percutaneous biopsy; however, laparoscopy is recommended due to the better detection rate, low complication rate and its ability to differentiate other diseases, such as peritoneal carcinomatosis and lymphomas. Antituberculous drugs are the primary treatment. An acute abdomen can occur in up to approximately 30% of cases. Complications such as strictures and perforations require surgical treatment.

Conclusion

Although the prevalence of TB is decreasing, the infection causes more than 1 million deaths per year. The correct diagnosis can be impeded by a misleading clinical presentation. A multidisciplinary approach enables rapid and efficient diagnostics and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Fahlbusch T, Künzli B, Schlottmann R et al (2019) Tuberculosis mimicking disseminated peritoneal carcinomatosis of a sigmoid carcinoma. J Gastrointest Surg 23(4):877–878. https://doi.org/10.1007/s11605-018-3800-3

    Article  PubMed  Google Scholar 

  2. Evans RPT, Mourad MM, Dvorkin L, Bramhall SR (2016) Hepatic and intra-abdominal tuberculosis: 2016 update. Curr Infect Dis Rep 18(12):45. https://doi.org/10.1007/s11908-016-0546-5

    Article  PubMed  Google Scholar 

  3. Wilhelm TJ, Post S (2018) Globalisierung: Abdominalchirurgische Herausforderungen bei Patienten mit Migrationshintergrund [Globalization: Challenges in abdominal surgery for migrants and refugees]. Chirurg 89(3):197–204. https://doi.org/10.1007/s00104-017-0584-z

    Article  CAS  PubMed  Google Scholar 

  4. WHO. https://www.who.int/healthinfo/global_burden_disease/en/. Zugegriffen: 03.04.2019

  5. WHO. https://www.who.int/tb/publications/global_report/en/. Zugegriffen: 03.04.2019

  6. American Thoracic Society, The Centers for Disease Control and Prevention (2000) Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 161(4 Pt 1):1376–1395. https://doi.org/10.1164/ajrccm.161.4.16141 (This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999.)

    Article  Google Scholar 

  7. Tan K‑K, Chen K, Sim R (2009) The spectrum of abdominal tuberculosis in a developed country: A single institution’s experience over 7 years. J Gastrointest Surg 13(1):142–147. https://doi.org/10.1007/s11605-008-0669-6

    Article  PubMed  Google Scholar 

  8. Guthmann J‑P, Haas W (2019) Tuberculosis in the European Union/European economic area: Much progress, still many challenges. Euro Surveill. https://doi.org/10.2807/1560-7917.ES.2019.24.12.1900174

    Article  PubMed  PubMed Central  Google Scholar 

  9. Naing C, Mak JW, Maung M et al (2013) Meta-analysis: The association between HIV infection and extrapulmonary tuberculosis. Am J Physiol 191(1):27–34. https://doi.org/10.1007/s00408-012-9440-6

    Article  Google Scholar 

  10. Yang Z, Kong Y, Wilson F et al (2004) Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis 38(2):199–205. https://doi.org/10.1086/380644

    Article  PubMed  Google Scholar 

  11. Weledji EP, Pokam BT (2017) Abdominal tuberculosis: Is there a role for surgery? World J Gastrointest Surg 9(8):174–181. https://doi.org/10.4240/wjgs.v9.i8.174

    Article  PubMed  PubMed Central  Google Scholar 

  12. Badaoui E, Berney T, Kaiser L et al (2000) Surgical presentation of abdominal tuberculosis: A protean disease. Hepatogastroenterology 47(33):751–755

    CAS  PubMed  Google Scholar 

  13. Mehta JB, Dutt A, Harvill L et al (1991) Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era. Chest 99(5):1134–1138

    Article  CAS  Google Scholar 

  14. Fillion A, Ortega-Deballon P, Al-Samman S et al (2016) Abdominal tuberculosis in a low prevalence country. Med Mal Infect 46(3):140–145. https://doi.org/10.1016/j.medmal.2016.02.003

    Article  CAS  PubMed  Google Scholar 

  15. Uzunkoy A, Harma M, Harma M (2004) Diagnosis of abdominal tuberculosis: Experience from 11 cases and review of the literature. World J Gastroenterol 10(24):3647–3649

    Article  Google Scholar 

  16. Wariyapperuma UM, Jayasundera CIW (2015) Peritoneal tuberculosis presenting with portal vein thrombosis and transudative ascites—A diagnostic dilemma: Case report. BMC Infect Dis 15:394. https://doi.org/10.1186/s12879-015-1122-6

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hassan I, Brilakis ES, Thompson RL et al (2002) Surgical management of abdominal tuberculosis. J Gastrointest Surg 6(6):862–867

    Article  Google Scholar 

  18. Rana S, Farooqui MR, Rana S et al (2015) The role of laboratory investigations in evaluating abdominal tuberculosis. J Family Community Med 22(3):152–157. https://doi.org/10.4103/2230-8229.163029

    Article  PubMed  PubMed Central  Google Scholar 

  19. Akinkuolie AA, Adisa AO, Agbakwuru EA et al (2008) Abdominal tuberculosis in a Nigerian teaching hospital. Afr J Med Med Sci 37(3):225–229

    CAS  PubMed  Google Scholar 

  20. Târcoveanu E, Dimofte G, Bradea C et al (2009) Peritoneal tuberculosis in laparoscopic era. Acta Chir Belg 109(1):65–70

    Article  Google Scholar 

  21. WHO. https://www.who.int/tb/publications/2010/9789241547833/en/. Zugegriffen: 06.04.2019

  22. Critchley JA, Young F, Orton L et al (2013) Corticosteroids for prevention of mortality in people with tuberculosis: A systematic review and meta-analysis. Lancet Infect Dis 13(3):223–237. https://doi.org/10.1016/S1473-3099(12)70321-3

    Article  CAS  PubMed  Google Scholar 

  23. Amarapurkar DN, Patel ND, Amarapurkar AD (2008) Hepatobiliary tuberculosis in Western India. Indian J Pathol Microbiol 51(2):175–181

    Article  Google Scholar 

  24. Chalasani NP, Hayashi PH, Bonkovsky HL et al (2014) ACG clinical guideline: The diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol 109(7):950–966. https://doi.org/10.1038/ajg.2014.131 (quiz 967)

    Article  PubMed  Google Scholar 

  25. Marshall JB (1993) Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 88(7):989–999

    CAS  PubMed  Google Scholar 

  26. Rathi P, Gambhire P (2016) Abdominal tuberculosis. J Assoc Physicians India 64(2):38–47

    PubMed  Google Scholar 

  27. Pattanayak S, Behuria S (2015) Is abdominal tuberculosis a surgical problem? Ann R Coll Surg Engl 97(6):414–419. https://doi.org/10.1308/rcsann.2015.0010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Krishnanand K, Chanchlani R, Chanchlani M et al (2013) A study of clinical presentation and management of abdominal tuberculosis in a tertiary care hospital. J Evol Med Dent Sci 2(46):8925–8931. https://doi.org/10.14260/jemds/1550

    Article  Google Scholar 

  29. Pujari BD (1979) Modified surgical procedures in intestinal tuberculosis. Br J Surg 66(3):180–181

    Article  CAS  Google Scholar 

  30. Kapoor VK (1998) Abdominal tuberculosis. Postgrad Med J 74(874):459–467

    Article  CAS  Google Scholar 

  31. Ghoneim I, Zuhdi Z, Arrifin AC et al (2015) Mistaking primary hepatic tuberculosis for malignancy: Could surgery have been avoided? Formos J Surg 48(3):94–97. https://doi.org/10.1016/j.fjs.2014.12.004

    Article  Google Scholar 

  32. Shen Z, Liu H (2013) Pancreatobiliary and peripancreatobiliary tuberculosis: A rare cause of obstructive jaundice. Arch Med Sci 9(6):1152–1157. https://doi.org/10.5114/aoms.2013.39799

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Danksagung

Abb. 2 wurde freundlicherweise von Frau Prof. Dr. A. Tannapfel, Institut für Pathologie, Ruhr-Universität Bochum zur Verfügung gestellt.

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland

    T. Fahlbusch,  C. Braumann &  W. Uhl

Authors
  1. T. Fahlbusch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Braumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Uhl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Fahlbusch.

Ethics declarations

Interessenkonflikt

T. Fahlbusch, C. Braumann und W. Uhl geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fahlbusch, T., Braumann, C. & Uhl, W. Therapie der abdominellen Tuberkulose. Chirurg 90, 818–822 (2019). https://doi.org/10.1007/s00104-019-0999-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-019-0999-9

Schlüsselwörter

Keywords

Search

Navigation