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Abdominal tuberculosis.

M P Sharma1, Vikram Bhatia

  • 1Department of Gastroenterology, All India Institute of Medical Sciences, D II/23, Ansari Nagar, New Delhi 110-029, India. mpsharma_s@hotmail.com

The Indian Journal of Medical Research
|November 3, 2004
PubMed
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Abdominal tuberculosis, a common extrapulmonary form of tuberculosis, affects the gastrointestinal tract. Its incidence is rising with HIV, presenting diverse symptoms and requiring various diagnostic tools for effective management.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Pulmonology

Background:

  • Tuberculosis (TB) frequently involves the gastrointestinal tract, ranking as the sixth most common site for extrapulmonary TB.
  • The increasing prevalence of HIV infection is associated with a rise in both the incidence and severity of abdominal tuberculosis.
  • Mycobacterium tuberculosis reaches the GI tract through hematogenous spread, infected sputum ingestion, or direct extension from adjacent infected tissues.

Purpose of the Study:

  • To provide a comprehensive overview of abdominal tuberculosis, encompassing its pathology, clinical presentations, diagnostic modalities, and management strategies.
  • To highlight the increasing significance of abdominal TB in the context of the HIV/AIDS epidemic.

Main Methods:

  • Review of gross pathology characterized by transverse ulcers, fibrosis, bowel wall thickening/stricturing, enlarged mesenteric lymph nodes, omental thickening, and peritoneal tubercles.

Related Experiment Videos

  • Description of three forms of peritoneal tuberculosis: wet (ascites), dry (adhesions), and fibrotic (omental thickening, loculated ascites).
  • Discussion of diagnostic tools including imaging (barium studies, CT, ultrasound), ascitic fluid analysis (protein, SAAG, cell count, ADA), and laparoscopy.

    • Main Results:

    • The ileocecal region is the most common site for gastrointestinal tuberculosis.
    • Ileocecal and small bowel TB often manifest as a right lower quadrant mass, obstruction, perforation, or malabsorption.
    • Rare presentations include dysphagia, dyspepsia, gastric outlet obstruction, hematochezia, rectal strictures, and perianal fistulae.

    Conclusions:

    • Abdominal tuberculosis presents with varied clinical and pathological features, necessitating a high index of suspicion, especially in HIV-infected individuals.
    • A combination of clinical evaluation, imaging, laboratory tests, and potentially laparoscopy is crucial for accurate diagnosis.
    • Standard management involves a minimum of 6 months of antitubercular therapy, with conservative surgical approaches being preferred.