Abdominal Tuberculosis

Abstract

Background : Tuberculosis (TB) is common form of communicable disease in India. Abdominal TB is one of the most common yet misdiagnosed forms of extrapulmonary TB. It is missed due to its similarity to other conditions such as Crohn's disease and nonspecific clinical presentation. Methods: Medical records of 317 patients who were diagnosed with abdominal TB from August 2015 to December 2020 were reviewed retrospectively from our prospectively maintained database. Results: Among 317 patients, 167 (52.7%) were male. Median age of presentation was 45 (8–85) years. Luminal involvement was seen in most of the patients (n = 157, 49.5%), followed by peritoneal (n = 63, 19.8%), mixed (n = 42, 13.2%), solid visceral (n = 30, 9.4%), and nodal (n = 25, 7.8%) involvement. Two hundred and sixty-one (82.3%) showed complete response. Seven (2.2%) patients died and 5 (1.6%) patients lost to follow-up. Median duration of treatment was 28 (25–52) weeks. Drug-induced liver injury was identified in 30 (9.5%) patients. Median follow-up duration was 32 (1–70) months. Conclusion: Abdominal TB is quite a diagnostic challenge due its vague clinical symptoms, nonspecific radiological features, and poor sensitivity and specificity of diagnostic tests. Hence, clinicians should have a high index of suspicion to diagnose and treat this treatable yet lethal condition promptly. Most cases respond very well to medical management and a small fraction requires surgical intervention if diagnosed early.

Left-Sided Colonic Tuberculosis Presenting as Colonic Stricture: A Rare Presentation of a Common Disease

“…TB is primarily a disease of the lungs, and although extrapulmonary TB can affect 15% of cases, luminal gastrointestinal TB is encountered in nearly half of the population among them. 1 , 4 The terminal ileum is the most commonly involved anatomical location in gastrointestinal TB, and the cecum is the most commonly involved site in colonic TB. 3 TB involves the abdomen through various routes, including ingestion of infected food or milk (primary intestinal TB) or infected sputum (secondary intestinal TB), hematogenous spread from distant tubercular focus, contiguous spread from infected adjacent foci, or through lymphatic channels.…”

“…The treatment is to be administered for at least 6–12 months. 3 , 4 Surgical treatment is reserved for refractory cases of TB who continue to have chronic malnutrition because of malabsorption or chronic abdominal pain with altered bowel habits affecting the quality of life. In general, the management of left-sided mechanical obstruction of the colon varies from primary resection with or without a primary reconstruction with or without a stoma; or a primary colonic diversion using an ileostomy or a colostomy; or endoluminal colonic stenting as a bridge to elective surgery.…”

Abdominal Tuberculosis Presenting as an Umbilical Sinus: A Case Report

“…Peritoneal tuberculosis is not uncommon, factors such as migration, the epidemic of AIDS, and an increase in the use of immunosuppressive therapy have led to its resurgence in recent years [ 6 ]. The diagnosis of this condition is difficult owing to its variability of presentation, non-specific radiologic signs, vague symptoms, and the insidious nature of the disease [ 5 , 7 ].…”

A Rare Case of Intestinal Tuberculosis with Chronic Partial Small Bowel Obstruction in a 37-Year-Old Ethiopian Man

“…2,7,17 Intestinal TB resembles other inflammatory and neoplastic conditions in the intestine. 18 Because of this, the rate of misdiagnosis reaches 50-70%, even in countries where TB is endemic. [2][3][4]14,18 This would result in treating TB patients with steroids and biological agents, which has the potential to cause disease progression and causes increased morbidity and mortality.…”

“…Terminal ileum and cecum are the two commonly affected regions because of abundant lymphoid tissue, physiologic stasis, limited digestive activity and increased fluid and electrolyte absorption rate. 10 , 11 , 13 , 15 , 17 , 18 On gross appearance, there are three types of lesions of intestinal TB: ulcerative (60%), hypertrophic/hyperplastic (10%), and ulcero-hypertrophic types (30%). The hypertrophic type is the less frequent form that causes luminal narrowing and intestinal obstruction.…”