The spectrum of abdominal tuberculosis in a developed country: a single institution's experience over 7 years

The incidence of human immunodeficiency virus (HIV) infection is rising, and as a result, tuberculosis (TB) has become a resurgent problem in many developed countries.

The aim of this study was to review the spectrum of abdominal TB and its surgical management in our institution.

A retrospective review of all abdominal TB cases notified to the health authorities by our institution from Jan 01 to Oct 07 was performed.

There were 57 patients (37 men) with abdominal TB, with a median age of 47 (range 14-74) years. Active pulmonary TB was present in 27 patients (47%). Positive HIV status was present in 30% and untested in 58%. The majority of patients underwent computed tomography scans (n = 50, 88%). The main radiological findings included bowel thickening, lymphadenopathy, ascites, free gas suggestive of perforation, and abscesses. The diagnosis of TB was confirmed on microbiological and/or histological examination in 72%, while the remaining 28% were diagnosed based on the clinical presentation and radiological imaging. All patients were commenced on anti-tuberculous therapy. TB involved the small or large bowel in 33 patients, mesenteric lymphadenopathy in 24, peritoneum in 13, spleen in seven, pancreas in two, anus in two, and the liver in two. Disseminated (including pulmonary) TB occurred in 27 patients (47%), while isolated intra-abdominal TB occurred in the remaining 30 patients (53%). Twenty-five patients (44%) underwent surgery--16 laparotomies (six perforated viscus, five intestinal obstruction, three suspected malignancies, and two for suspected acute abdomen), five laparoscopic procedures (four diagnostic, one gastrojejunostomy bypass for gastric outlet obstruction), two appendectomies, one drainage of abscess, and one anal fistulotomy.

Although TB is eminently treatable medically, surgery is still often required for suspected or confirmed abdominal TB presenting with acute complications or as atypical diagnostic problems. The role of laparoscopy is likely to be more significant in future in the management of abdominal TB.