A clinical dilema- abdominal tuberculosis

Tuberculosis hasplagued mankind since Neolithic times (8000 BC). The accurate diagnosis of abdominal tuberculosis requires a high index of suspicion. It may involve the gastrointestinaltract, peritoneum, lymph nodes or solid viscera,constitutes up to 12% of extra pulmonary TB and 1–3% of the total. IJABMS July 2014 page Number 22

To study the clinical profile of abdominal tuberculosis with emphasis on presentation, investigation, diagnosis, treatment and follow-up.

A study of 124 patients of abdominal tuberculosis was done between January2010 to June2013 by reviewing their clinical information, therapeutics and outcomes. Diagnosis was based on clinicalfeatures, imaging techniques and/or histo-pathology.

124 cases of ATB were studied. Median age was 33.1 years, with M: F ratio is 1:1.06. The common symptoms were Abdominal pain,weight loss, fever, and anorexia. Common clinical signs were pyrexia, ascites and abdominal tenderness. Sub-acute and acuteintestinal obstructions were seen in 16 and 4 patients respectively. Laparoscopyand laparotomy had a high percentage of making diagnosis of Abdominal TB. In 100 patients, granulomatous lesion and/or Langhan's giant cells were found confirming diagnosis of tuberculosis, while 3 patients were diagnosed by positive acid-fast culture. In 21 patients with suggestive clinical history and negative diagnostic workup, response to therapeutic trial of anti TB drugs was the basis of diagnosis. 87 patients responded to medical treatment and 37patients with complications required additional surgical intervention. Total 15 patients died and no case of relapse was noted.

Abdominal tuberculosis can be difficult to diagnose because of the variable presentation, the low percentage with positive microscopy for acid-fast bacilli and the time delay of up to several weeks for a positive TB culture. The thresholds for laparoscopy and/or laparotomy for the diagnosis were low but diagnosis could be made rapidly and early treatment ca be instituted. Six months short-course chemotherapy is very effective in ATB.