Diagnostic dilemmas in abdominal tuberculosis in children

Abstract

The authors review 45 pediatric patients with intra-abdominal tuberculosis (ATB) treated between May 1990 and April 1998. The diagnosis was confirmed histologically or by positive culture for Mycobacterium tuberculosis. Clinical presentation was with an abdominal mass (12), subacute obstruction (11), ascites (5), mass and ascites (4), peritonitis (4), and 9 unusual presentations. Mantoux tests were positive in 68% of patients tested. There were radiologic features suggestive of pulmonary TB in 29 patients (64%); abnormal abdominal radiographs were recorded in 21 (47%). Lymphadenopathy was noted on abdominal ultrasound in 23 of 30 patients (77%) and on computed tomography scan in a further 3 of 8 patients investigated. Ascitic fluid adenosine deaminase (ADA) levels were greater than 30 IU/l in 3 of 4 patients (75%), suggesting ATB. All 28 patients screened for human immunodeficiency virus were negative. A surgical procedure was performed in 39 patients. 29 (74%) had an elective diagnostic laparotomy for tissue diagnosis. One (3.4%) developed a postoperative intra-abdominal abscess. Ten (26%) presented with complications requiring surgical intervention including perforated viscus, segmental bowel resection, strictureplasty, adhesiolysis, or ileostomy. One of the latter died due to sepsis after having complications of persistent intestinal obstruction and cecal perforation. The authors recommend an aggressive approach to patients with suspected ATB in order to obtain an early definitive diagnosis, prevent complications, and reduce morbidity and mortality. They emphasize the importance of tissue diagnosis and confirmation by culture.

Tuberculous peritonitis in children: Report of nine patients and review of the literature

“…One patient (patient 1) presented with small-bowel obstruction due to chronic peritoneal inflammation and adhesions. Intestinal obstruction developed in patients with TBP is also reported in the other studies [4,[11][12][13] . Due to the nonspecific symptoms and physical findings, diagnosis is often delayed.…”

Paediatric abdominal tuberculosis in developed countries: case series and literature review

“…Differentiating between GIT TB and Crohn's disease is important in countries with a low incidence of TB as immigration and travel are increasing and immunosuppressant agents are often used in the treatment of Crohn's disease 34 . M. tuberculosis is grown from an abdominal specimen in only 36–40% of cases and may take 6–8 weeks 30 33. Ziehl–Neelsen staining is positive in only 32–35% and lacks specificity 21 27 30.…”

Clinical Presentation in a Series of Eight Children with Abdominal Tuberculosis: Experience of a Single-Center in Turkey

“…Chest radiographs were reported to be abnormal in 50% to 75% of abdominal TB patients (3,10,31). In the present study, the chest radiographs of seven patients (one had no chest radiograph) clearly indicated lung involvement of TB.…”