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From 1972 to 1989, 20 cases of tuberculous peritonitis were seen in Tokyo Metropolitan Geriatric Hospital. In 13 patients the diagnosis of tuberculous peritonitis was made only at autopsy, which in 7 patients was made during life. Of all 20 cases the mean age was 78 years, with a range of 63 to 96 years. There were no differences in mean ages between autopsied patients and clinically diagnosed patients. There were 11 male and 9 female patients. In autopsied patients 6 were male and 7 were female. Of the clinically diagnosed patients 5 were male and 2 were female. Seven of 13 patients who were diagnosed at autopsy had liver diseases, for example liver fibrosis, liver cirrhosis, hepatocellular carcinoma or chronic hepatitis. In 4 of 7 patients who were diagnosed during life, ileus was also present and their diagnosis of tuberculous peritonitis was made at operation. Only 6 patients had tuberculin test with intermediate strength PPD. There were no positive reactions. In patients who were diagnosed during life, abdominal swelling, anorexia, abdominal pain and fever, the most common clinical manifestations, were seen in 100%, 75%, 50% and 86%, respectively. In contrast, they were seen in 33%, 57%, 0% and 62%, respectively, in autopsied patients. The volume of ascitic fluid varied from zero to 3000 cc. Total white-cell count in the peripheral blood was within or lower than the normal range in 85% of all 20 cases. The lymphocytes count in the peripheral blood was decreased in 95% of all 20 cases. There were no characteristic features in the serum biochemical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and pathological features of tuberculous peritonitis in the elderly.