170 Journal of Digestive Diseases 2008; 9; 170–174 doi: 10.1111/j.1751-2980.2008.00340.x Blackwell Publishing Asia Melbourne, Australia CDD Chinese Journal of Digestive Diseases 1443-9611 1443-9573 © 2008 The Authors Journal compilation © 2008 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology and Blackwell Publishing Asia Pty Ltd. XXX Other TBP: a clinical review OK Poyrazoglu et al. Clinical review of 23 patients with tuberculous peritonitis: Presenting features and diagnosis Orhan K POYRAZOGLU,* Mustafa TIMURKAAN, † Mehmet YALNIZ,* Huseyin ATASEVEN,* Muruvvet DOGUKAN ‡ & Ibrahim H BAHCECIOGLU* Firat University Medical Center, *Division of Gastroenterology, † Department of Internal Medicine, ‡ Department of Microbiology and Clinical Microbiology, Elazig, Turkey OBJECTIVE: To better identify which clinical, labo- ratory, radiological and invasive procedures were most useful in diagnosing tuberculous peritonitis and to assess the methods in order to reach the diagnosis in future cases. METHODS: Tuberculous peritonitis cases diagnosed between 2000 and 2006 were reviewed retrospectively. Their clinical presentation, physical examination, laboratory and diagnostic methods were evaluated. RESULTS: Twenty-three cases of tuberculous peritonitis were diagnosed. The mean age of the patients were 30 ± 11 years and 16 were women. The mean duration of symptoms prior to diagnosis was 3.6 months. All patients presented with abdominal pain. Abdominal swelling (91.3%), loss of appetite (87%) and weight loss (82.6%) were the other commonest symptoms. The major physical findings were ascites (78.3%) and fever (60.9%). The serum ascites albumin gradient was <1.1 g/dL in all. An ascites fast bacilli smear was positive in 12 (52.2%) patients. Skin tests with purified protein derivative, adenosine deaminase and polymerase chain reaction were performed in seven, four and five patients, respectively. The tuberculous culture was positive in only two. The most common radiological findings were ascites (100%) and omental involvement (65.2%). A laparoscopy was performed in nine of 23 patients. A total of 22 patients completed anti-tuberculous therapy successfully and were cured, except one with cirrhosis. CONCLUSION: Tuberculous peritonitis may be fatal but is medically cured if diagnosed in a timely fashion. Although both non-invasive and invasive tests have additional benefits, clinician suspicion is still the first step for the diagnosis of tuberculous peritonitis. KEY WORDS : abdominal, diagnosis, extra-pulmonary, peritonitis, tuberculosis. Tuberculosis (TB) remains a serious public health problem, particularly in developing and undeveloped countries worldwide. There has been an increase in the number of patients diagnosed with abdominal TB in the rest of the world where TB used to be rare. This is particularly a result of increasing travel, migration and human immune deficiency virus infection. 1,2 Abdominal TB is one of the most common extrapulmonary sites of TB infection. The reported incidence of tuberculous peritonitis (TBP) among all forms of TB varies from 0.1–0.7% worldwide. 3 In addition, it is often misdiag- nosed because of its insidious nature and the variability of its clinical presentation and the lack of pathogno- monic findings, leading to delay the diagnosis and the treatment of TBP. This can lead to morbidity and even mortality. 4–7 In the present study we assessed the clinical presentation, biochemical, laboratory and radiological findings of TBP to ascertain whether we can reach a diagnosis early by selecting the correct tools. Correspondence to: Orhan K POYRAZOGLU, Firat University, Medical Center, Department of Internal Medicine, Division of Gastroenterology, 23200, Elazig, Turkey. Email: okpoyrazoglu@yahoo.com  2008 The Authors Journal compilation  2008 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology and Blackwell Publishing Asia Pty Ltd.