Surgical presentation of abdominal tuberculosis: a protean disease

The incidence of tuberculosis is rising again in the Western world, due to the emergence of new groups of patients at risk. This paper intends to describe the various patterns of surgical presentation of abdominal tuberculosis in an industrialized country.

A retrospective study was made of all patients admitted to our surgical institution, and in whom a diagnosis of abdominal tuberculosis was established. Eleven patients were identified. Ten of them were migrants from countries endemic for tuberculosis.

Six patients presented with acute abdominal pain (3 in right lower quadrant) and had surgery in emergency. Two patients had elective surgery for diagnostic purposes. Two patients underwent other invasive diagnostic and/or therapeutic procedures. One patient was treated conservatively. Unusual presentations included 2 patients with periportal lymphadenitis and compressive features on the main bile duct and/or the portal vein, and 1 patient with acute duodenal tuberculous perforation. The main localization of disease was lymph nodes for 5 patients, intestinal for 4 and peritoneal for 2.

Surgeons must be aware of the wide clinical spectrum of abdominal tuberculosis and have a high index of suspicion when confronted with patients from an endemic area and presenting with unclear abdominal symptoms.