Clinical diagnosis of abdominal tuberculosis

One hundred and eighty-two cases of abdominal tuberculosis admitted to Swaroop Rani Nehri (SRN) Hospital, Allahabad, in the past 7 years have been reviewed. The clinical diagnosis of abdominal tuberculosis was made correctly only in 50 per cent of cases. About half the cases presented with chronic or acute on chronic intestinal obstruction. The remaining patients had vague pains, tender abdomen, constitutional symptoms or a mass in the abdomen. Diarrhoea was not frequent and fistula formation was rare. A chronic obstructive type of lesion was found not only in cases with a bowel lesion but also in patients with chronic miliary peritonitis and tuberculous mesenteric adenitis. Similarly, a lump was present not only in hypertrophic bowel tuberculosis but also in chronic miliary peritonitis and tuberculous mesenteric adenitis. On radiological examination false positive features such as fluid levels, bowel dilatation or even the 'string' sign were encountered. Liver and endometrial biopsies were positive in only a very few cases. Peritoneal biopsy was of considerable help, being positive in 88 per cent of ascitic cases and in 42-1 per cent of non-ascitic cases. Open peritoneal biopsy obtained after making a small incision in the right iliac fossa was found to be the most useful investigation in the diagnosis of abdominal tuberculosis. An ascitic fluid protein content of 2-5 g or more and a predominantly lymphocytic count of over 100/mm3 are diagnostic, but a cell count of 10/mm3 was recorded in one tuberculous case.