Laparoscopic management of midgut malrotation and tuberculous peritonitis in an adolescent boy

Abstract

An unusual case of miliary plastic peritonitis associated with midgut malrotation in an adolescent in whom various diagnostic investigations, medical management and staged initial laparoscopic diagnostic followed by therapeutic procedure was curative have been presented. Tuberculous miliary plastic peritonitis causes dense adhesions between bowel loops and prevents midgut volvulus in a pre-existing malrotation. Diagnosis can be a challenge and threshold for diagnostic laparoscopy should be low. Interval correction of malrotation by laparoscopy after complete resolution of tuberculosis is easy, safe and effective, and cosmetically more pleasing. Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of fetal axis around the axis of superior mesenteric artery during fetal development. Most patients present with bilious vomiting in the first month of life because of duodenal obstruction or a volvulus. This is an unusual case of midgut malrotation in association with tuberculous peritonitis in an adolescent boy.

Paediatric abdominal tuberculosis in developed countries: case series and literature review

“…Eleven of the 19 cases of peritoneal TB could be further divided into one of the three types 14 20 21 23 25 26 29. Nine (82%) had a predominantly fibrotic type and two (18%) had a predominantly dry type.…”

“…Steroids in addition to antituberculous drugs were started in seven cases 8 14 29. Follow-up data were available for two of these cases, ranging from 9 months to 6 years 14 29.…”

“…Follow-up data were available for two of these cases, ranging from 9 months to 6 years 14 29. Neither patient developed complications related to abdominal TB during their follow-up period.…”

Peritoneal Tuberculosis in Children Over the Last Decade: A Systematic Literature Review

“…For instance, it took about 2 weeks to set the peritoneal TB diagnosis in our patients. Additionally, the peritoneal TB diagnosis for children is rarely suspected only upon clinical presentation [12]. As this study shows, the most common observed symptoms were unspeci c and very common for every sick child: abdominal pain with distention and fever.…”

“…These were the reasons why we conducted this systematic review and analysis. As our study shows, individual cases of peritoneal TB in children are observed in regions with a different morbidity of TB, social and economic status including experience of four different continents -most of cases presented from India (11), Tunisia (11) and Turkey (10) and others from Saudi Arabia, Italy, Germany, United Kingdom, Canada, Taiwan and United States of America [3,4,[7][8][9][10][11][12][13][14][15].…”