Umbilical Signs of Peritoneal Tuberculosis in Children

• Published in: Indian journal of pediatrics 2012-09, Vol.79 (9), p.1192-1196
• Main Authors: Pant, Nitin, Choudhury, S. Roy, Gupta, Amit, Yadav, Partap S., Grover, Jitendra Kumar, Chadha, Rajiv
• Format: Article
• Language: English
• Subjects: Antitubercular Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Child; Child, Preschool; Female; General aspects; Gynecology; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Medicine; Medicine & Public Health; Original Article; Pediatrics; Peritonitis, Tuberculous - diagnosis; Peritonitis, Tuberculous - pathology; Peritonitis, Tuberculous - therapy; Retrospective Studies; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Gastrointestinal - diagnosis; Tuberculosis, Gastrointestinal - drug therapy; Tuberculosis, Gastrointestinal - surgery; Umbilicus - pathology
• ISSN: 0019-5456; 0973-7693
• DOI: 10.1007/s12098-011-0643-2

Objectives To report the observation of involvement of the umbilicus with alteration of its morphology in association with peritoneal tuberculosis. Methods This is a retrospective observational case series of abdominal tuberculosis (ATB) in children, treated in the department of pediatric surgery of a tertiary-care children’s hospital in the period from January 2004 through April 2010. Results Out of a total of 38 cases of ATB in children, 22(57.9%) were of the peritoneal type, 14(36.8%) were of the intestinal type, and 2(5.3%) involved the mesenteric lymph nodes. Of the patients manifesting with peritoneal tuberculosis, 11 cases (50%) had involvement of the umbilicus with changes in the umbilical shape and appearance. In seven cases the umbilicus was found retracted and transversely oriented (a slit-like “smiling” appearance) with loss of the umbilical hollow. In two cases there was puckering of the umbilicus. Other findings included umbilical erythema with inflammation in one patient and a fecal fistula at the umbilicus in another patient. While seven cases responded to treatment with antituberculous therapy (ATT), four cases underwent surgery (two laparotomy and two laparoscopy). Findings were similar in all four patients, consisting of adhered dilated bowel loops studded with tubercles which also covered the parietal peritoneum and the falciform ligament. All four cases responded to postoperative ATT. Conclusions Morphological changes of the umbilicus can provide an additional clue to the diagnosis of peritoneal tuberculosis in children.