Abdominal tuberculosis. On-going challenge to gastroenterologists

OBJECTIVE: The aim of this study is to record the observations and experience on the diagnosis and management of abdominal tuberculosis (TB) and to highlight the difficulties in the diagnosis and management of this condition.

METHODS: Two hundred consecutive patients attending the Gastroenterology Department of the King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia between May 1991 and May 2001, suspected with abdominal TB were investigated. A detailed clinical history and physical examination were obtained. Data of 75 confirmed cases of abdominal TB were analyzed.

RESULTS: The most common presenting symptoms were anorexia (84%), abdominal pain (84%) and weight loss (72%). Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass (42%). The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients (32%). Computed tomographic (CT) scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. The most common presenting symptoms were anorexia (84%), abdominal pain (84%) and weight loss (72%). Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass (42%). The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients (32%). Computed tomographic (CT) scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients.

CONCLUSION: A high index of clinical suspicion is required to make an early diagnosis of abdominal TB. Suspicion should be aroused, particularly in patients having a combination of anorexia, abdominal pain, weight loss and ascites. Diagnosis requires the utilization of a combination of various diagnostic procedures especially abdominal ultrasound, CT scan and endoscopy, which provides a high diagnostic yield in this disease. A normal chest radiograph does not exclude the presence of abdominal TB. A timely use of laparoscopy are often required to prevent surgical intervention.