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Abdominal Tuberculosis: A Diagnostic Dilemma
Seema Awasthi1, Manoj Saxena2, Faiyaz Ahmad2
1Associate Professor, Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre , Moradabad, India .
Background:
Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management.
Aim:
To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment.
Materials And Methods:
A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases.
Results:
Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put on anti-tubercular treatment and majority showed good response to therapy.
Conclusion:
Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. Study of histopathological findings can aid in the diagnosis in the settings where advanced molecular methods of diagnosis are not available, leading to early diagnosis and management.
Insights
Abdominal tuberculosis presents with vague gastrointestinal symptoms, often mimicking other disorders. Histopathology is crucial for diagnosis in resource-limited settings, enabling timely treatment and improved patient outcomes.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pathology
Background:
- Abdominal tuberculosis (TB) is an increasingly common extrapulmonary TB form, affecting the gastrointestinal tract, peritoneum, and hepato-biliary system.
- Non-specific clinical manifestations of abdominal TB often lead to delayed diagnosis and management.
- Rising incidence necessitates improved diagnostic strategies, especially in resource-poor settings.
Purpose of the Study:
- To evaluate clinical, radiological, and microbiological findings in abdominal tuberculosis.
- To define the role of histopathology in diagnosing abdominal TB in resource-limited areas.
- To analyze patient compliance and response to anti-tubercular treatment.
Main Methods:
- A 5-year retrospective study (2010-2014) included 48 patients diagnosed with abdominal TB at a tertiary hospital in Northern India.
- Clinical data, laboratory results, and imaging were analyzed.
- Histopathological examination of resected specimens included Ziehl-Neelsen (ZN) and Periodic acid-Schiff (PAS) staining.
Main Results:
- The average age of presentation was 27.4 years, with a male predominance (1.4:1).
- Abdominal pain (100%), anorexia (98%), fever (88%), and intestinal obstruction (88%) were common symptoms; the ileum was the most frequent site of involvement.
- Histopathology revealed epithelioid granulomas with necrosis and Langhans giant cells in most specimens; Acid Fast Bacilli (AFB) were detected in 5 cases. Majority responded well to anti-tubercular treatment.
Conclusions:
- Abdominal tuberculosis should be considered in patients presenting with nonspecific gastrointestinal symptoms.
- Histopathological examination is vital for diagnosing abdominal TB where advanced molecular diagnostics are unavailable.
- Early diagnosis and management through histopathology improve patient outcomes.
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