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

Abstract

Background: Tuberculosis remains a public health issue. Peritoneal tuberculosis is an uncommon form of tuberculosis and it accounts for less than 1% of all tuberculosis cases in children. The aim was to asses experience and struggles in diagnosing peritoneal tuberculosis in children.Methods: Systematic review of literature from the PubMed database was conducted including cases of children with peritoneal tuberculosis during 2008-2019 years. Results: The search yielded 2309 potentially relevant articles, 11 met inclusion criteria with total number of 48 patients (4 our cases, 44 from the literature). 29 (60.4%) were males with the median age of 11 years and 19 (39.6%) females with the median age of 10. The contact with active tuberculosis was reported in 16 cases (33.3%). Tuberculin skin test was performed in 42 cases (87.5%) with only 43.7% positive. The mean time from symptoms presentation until hospitalization was 30.6 days. The most common symptoms were abdominal pain (70.8%), abdominal distention (66.7%) and fever (54.2%). The most common ultrasound findings were free fluid in pelvic cavity (70.8%) and enlarged mesenteric lymph nodes (52.1%). The majority of culture for Mycobacterium tuberculosis samples were negative. Surgery was performed in 36 (75%) cases with the most common findings of tubercles (63.8%), peritonitis (41.6%) and ascites (36.1%). Histopathological biopsy evaluation was performed in 38 (79.2%) patients and in all cases tuberculosis granulomas were confirmed.Conclusions: Clinical presentation, laboratory and radiological findings are nonspecific for peritoneal tuberculosis in children. This systematic review shows that peritoneal tuberculosis was diagnosed by surgical intervention in most of the cases. Accordingly, we suggest the algorithm of less invasive procedures and tests before surgical intervention.