Diagnostic evaluation and management of abdominal tuberculosis

Abdominal Tuberculosis represents 11-16% of extrapulmonary tuberculosis and usually presents with vague abdominal symptoms that can mimic other diseases such as inflammatory bowel disorders, malignancy and sarcoidosis. Often the diagnosis is delayed and complications such as adhesions, obstruction, fistula or bleeding can occur. The common types are peritoneal and intestinal TB. Clinical findings should be complemented with appropriate imaging techniques such as ultrasound, CT/MRI scan, barium roentgenograms and endoscopy. Due to the paucibacillary nature, the sensitivity of AFB smear, culture, PCR assays are usually lower and interventional procedures such as endoscopy/laparoscopic biopsy should be promptly utilized wherever needed so as to initiate early treatment and avoid late complications. Standard anti-TB regimen (2RHZE/4RHE) usually achieve higher cure rates in drug sensitive TB. Close follow-up monitoring is needed to evaluate the effectiveness of proper and regular treatment. Endoscopic interventions or surgery may be required in managing complications.