Overview
Retroperitoneal tuberculosis mainly refers to tuberculosis of the retroperitoneal lymph nodes, excluding tuberculosis of the retroperitoneal organs, often secondary to tuberculosis of the lungs, lumbar vertebrae, or the twelve ribs, where tubercle bacilli enter the retroperitoneal space to form a retroperitoneal tuberculous abscess, also known as a cold abscess. It is mostly seen in children and adolescents. Retroperitoneal tuberculosis is characterized by insidious location, diverse clinical manifestations and lack of specific auxiliary examination, therefore, it has a high rate of underdiagnosis and misdiagnosis.
Etiology
This disease is caused by Mycobacterium tuberculosis, often secondary to pulmonary tuberculosis, lumbar spine tuberculosis or twelve ribs tuberculosis.
Symptoms
1. Symptoms
Symptoms are mostly non-specific, some patients are mainly characterized by chronic symptoms of tuberculosis such as low fever, night sweats, anemia and emaciation; some patients start with acute lymphadenitis, high fever, chills and abdominal pain; some patients are accompanied by digestive symptoms such as abdominal pain, nausea and vomiting. When a retroperitoneal tuberculosis abscess is formed, symptoms of different degrees of organ compression can occur. As retroperitoneal tuberculosis is often secondary to pulmonary tuberculosis, there are respiratory symptoms such as cough and sputum, and those secondary to spinal tuberculosis may have low back pain.
2. Physical signs
There may be pressure and rebound pain in the abdomen, but the abdominal muscle tension is not obvious, and there may be tenderness. Ascites can be seen in some patients, and the liver and spleen may be palpable. In severe cases, there may be signs of intestinal paralysis and low back pain on percussion.
Examination
1. Laboratory examination
Patients with active tuberculosis may show positive tuberculin test and rapid blood sedimentation.
2. Imaging examination
Ultrasound, chest X-ray, abdominal enhanced CT, MRI, etc. can help to understand the location and scope of the lesion.
Diagnosis
This disease from the clinical symptoms and signs only manifested as low or high fever, chronic abdominal pain, no specific signs, easy to be neglected, misdiagnosis, should pay attention to have a history of mistakenly clear tuberculosis or tuberculosis patients close contact history, for highly suspected of this disease can be carried out ultrasound, CT, tuberculin test, blood sedimentation, etc., and anti-tuberculosis diagnostic treatment if necessary.
Differential diagnosis
This disease needs to be differentiated from other diseases in the retroperitoneum, such as lymphoma, retroperitoneal metastases, primary abdominal tumors, abdominal or retroperitoneal abscesses.
Treatment
1. Drug therapy
When the disease is highly suspected, diagnostic anti-tuberculosis treatment can be carried out, but the time should not be too long so as not to delay the treatment. After the diagnosis is clear, regular anti-tuberculosis treatment should be given, and those who are accompanied by infection should be given antibacterial drugs or traditional Chinese medicine as appropriate.
2. Surgical treatment
For larger abscesses, incision and drainage should be carried out; for more limited masses or those with neighboring organs compressed by non-surgical treatments that are ineffective, surgical resection can be carried out; anti-tuberculosis treatment is still needed after the operation.