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Abdominal tuberculosis: still a problem today
Abstract:
Thirty cases of abdominal tuberculosis were diagnosed over an 18-year period, 26 being in immigrants; the mean age at presentation was 33 years. There were 25 cases of tuberculous peritonitis, two of tuberculous mesenteric lymphadenitis, and one each of gastric tuberculosis, colonic tuberculosis and tuberculous ischiorectal abscess. The presenting symptoms were of vague ill-health and not diagnostic, and the most common findings were of pyrexia, abdominal tenderness and ascites. The most common haematological abnormalities were raised ESR (22 patients) and mild anaemia (15 patients). Most commonly, diagnosis was made by formal laparotomy (19 cases) with biopsy (18 cases); histological examination gave a positive diagnosis in all 18 cases, but bacteriological examination yielded the tubercle bacillus in only 10 (56%). There were 2 deaths in the series, not directly related to the abdominal tuberculosis. In view of its infrequent and vague presentation, care is required to avoid overlooking the diagnosis of abdominal tuberculosis, particularly in the immigrant population.
Insights
Abdominal tuberculosis, often seen in immigrants, presents with vague symptoms like fever and abdominal pain. Diagnosis frequently requires laparotomy and biopsy, highlighting the need for awareness in at-risk populations.
Area of Science:
- Medical Microbiology
- Gastroenterology
- Epidemiology
Background:
- Abdominal tuberculosis (TB) is an uncommon condition with diverse presentations.
- Diagnosis can be challenging due to non-specific symptoms.
Purpose of the Study:
- To review cases of abdominal TB over an 18-year period.
- To identify diagnostic challenges and patient demographics.
Main Methods:
- Retrospective analysis of 30 abdominal TB cases.
- Review of presenting symptoms, clinical findings, hematological abnormalities, and diagnostic methods.
- Laparotomy and biopsy were key diagnostic tools.
Main Results:
- 26 of 30 cases (87%) occurred in immigrants.
- Tuberculous peritonitis was the most common form (25 cases).
- Vague ill-health, pyrexia, abdominal tenderness, and ascites were common presentations.
- Histological examination of biopsies confirmed TB in all cases, while bacteriology was positive in 56%.
Conclusions:
- Abdominal TB requires high clinical suspicion due to its infrequent and vague presentation.
- Early diagnosis is crucial, especially in immigrant populations.
- Histopathology is more reliable than bacteriology for diagnosis in this series.