25.08.

2022
Hernia simptomatik
MRCP
Indikasi dan persiapan perioperatif pasien TB abdomen
Salomonowitz E, Frick MP, Sommer G, Czembirek H. Symptomatic inguinal hernia:
association with intraabdominal mass lesions. Gastrointest Radiol. 1983;8(4):371-4.
doi: 10.1007/BF01948154. PMID: 6642156.
MRCP
• MRCP is a flow MRI sequence and it does not require intravenous contrast;
it can fully assess biliary obstruction, but cannot demonstrate its precise
nature.

• MRCP is very useful in case of biliary-digestive anastomosis because we have

the possibility to acquire images in any given, desired plane: coronal, oblique
sagittal, etc.

• MRCP - a very specific investigation for biliary pathology – precisely depicts

the location of the obstruction and thereafter the real distance to the papilla.
Also, MRCP precisely shows the calculi number, their size (starting from
1mm); anyway MRCP cannot depict the composition of thePetrescu
stones.
I, Bratu AM, Petrescu S, Popa BV, Cristian D,
Burcos T. CT vs. MRCP in choledocholithiasis jaundice. J
Med Life. 2015 Apr-Jun;8(2):226-31. PMID: 25866583;
PMCID: PMC4392096.
 Tuberculosis peritonitis
• Tuberculous peritonitis is usually due to reactivation of a tuberculous focus in
the peritoneum with concurrent pulmonary, intestinal or genital TB (especially
from the fallopian tubes).

• Peritoneal TB occur in three forms: Wet type with ascites, dry/plastic type
with adhesions, and fibrotic type with omental thickening and loculated
ascites.

• Peritoneal TB is characterized by tubercles that appear as white “seedlings” on

the parietal and visceral surfaces of the peritoneum. Inflammation and
exudation leads to the formation of straw-coloured ascites.
Tuberculosis peritonitis
• Neither clinical signs, laboratory, radiological and endoscopic
methods nor bacteriological and histopathological findings
provide a gold standard by themselves in the diagnosis of
abdominal TB.
• This diagnostic approach for abdominal TB should be as little
invasive as possible and be based on the best available imaging.
• CT findings suggestive of abdominal TB were mesenteric/omental
stranding (50%), ascites (37%), and retroperitoneal
lymphadenopathy (31%).
Tuberculosis peritonitis
• Invasive procedures are frequently necessary to obtain samples
but also for the treatment of digestive involvement.
• Peritoneal biopsy through laparoscopy has emerged as the gold
standard for diagnosis and both lymphoma and carcinomatosis can
be excluded by this means.
• While laparotomy will reveal the diagnosis in patients with
abdominal TB who present with an acute abdomen, the procedure
may be hazardous in sick, emaciated patients with malabsorptive
syndrome. It is also not always accurate for the “cold” cases and
laparotomy should be performed only when complications of
abdominal TB developed.
Tuberculosis peritonitis
• Surgery is essentially reserved for those with acute surgical complications
including free perforation, confined perforation with abscess or fistula,
massive bleeding, complete obstruction, or obstruction not responding to
medical management.

• Treatment for Peritoneal TB is pharmacologic, with the drug regimen

consistent with that used for pulmonary TB. Treatment duration consists of a four-
drug regimen (isoniazid (INH), RIF, pyrazinamide, ethambutol) administered for 2
months, with continuation of treatment with RIF and INH for 4 or more months.

• Response to therapy in Peritoneal TB is usually noted within the first 3 months

of treatment and is guided by the resolution of presenting symptoms, such as
ascites and normalization of laboratory values.