Pediatric Abdominal Tuberculosis: A Multicenter Experience from an Endemic Region

Abdominal tuberculosis (AbTB) is an extrapulmonary manifestation of tuberculosis (TB) that remains difficult to diagnose because its symptoms resemble many other gastrointestinal disorders. This study aimed to describe the clinical presentation, diagnostic evaluation, and treatment outcomes of pediatric AbTB treated at tertiary care centers in a lower middle-income country.

A retrospective review was conducted of children < 18 years who were diagnosed with AbTB between January 2012 and December 2024 at two tertiary care hospitals in Pakistan. Patients were categorized into medical and surgical groups based on definitive management. Descriptive and comparative analyses were performed. Statistical significance was defined as a p value ≤ 0.05.

Ninety six children were included of which 26 were male. The mean age was 11.8 years, and the mean weight was 26 kg. Abdominal pain (82%) was the most common symptom followed by fever (59%) and vomiting (51%). The pattern of presenting symptoms did not differ significantly between the medical and surgical groups. Computed tomography (81%) was the most frequently used imaging modality. Standard antituberculosis therapy was provided to all patients. Surgical intervention was required in 41 children mainly for bowel obstruction or perforation. The mean length of stay was significantly longer in the surgical group (13 ± 9 days vs 8 ± 9 days, p=0.004). Overall, seven (7.3%) patients experienced mortality. Mortality was higher in the surgical group although this difference was not statistically significant (p=0.5).

A large proportion of children present with advanced disease and require surgery. Improved access to imaging and strengthened referral and follow up systems are needed to achieve earlier diagnosis and reduce postoperative morbidity. Abbreviations: TB: Tuberculosis, AbTB: Abdominal tuberculosis,ATT: Anti- tuberculous therapy, LMIC: Low- and middle-income countries.