TUBERCULOSIS OF THE PERITONEUM AND GASTROINTESTINAL TRACT

Abstract

Tuberculosis of the peritoneum and gastrointestinal tract can mimic a variety of other abdominal disorders. Unless a high index of suspicion is maintained, the diagnosis can easily be missed or delayed, resulting in substantial increased morbidity and mortality.

The purpose of this study was to better identify which clinical, laboratory, radiologic, and invasive procedures were most used in diagnosing abdominal tuberculosis.

All cases of abdominal tuberculosis were diagnosed during the study period. There were 14 men and 7 women, median age was 32 (ranged within 22-63) years. Most patients presented with an abdominal pain, fever, and weight loss. Purified protein derivative (PPD) was only positive in 4 out of 21 patients. Chest radiographies were suggestive of pulmonary tuberculosis in 3 patients. Ultrasound examination of the abdomen was helpful in 6 patients, and computed tomographic scan was suspicious in 10 of the patients. Double-contrasted barium enema examination was helpful in 4 out of 6 patients. Adenosine deaminase activity was increased in 3 patients. Routine blood work was not helpful. Laparotomy and tissue biopsy of characteristic tissue for acid fast bacillus smear and culture was diagnostic in all patients. Once diagnosed, all patients responded rapidly to anti-tuberculosis therapy, except two patients with entero-cutaneous fistula who died shortly after diagnosis. A trend in earlier diagnosis was noted in recent years and is felt to be the result of an elevated index of suspicion.

Abdominal tuberculosis can mimic many abdominal disorders but is medically cured if diagnosed in a timely fashion. It is essential that the clinician suspect the disease in appropriate patients. In the present study, it is observed that the tests frequently associated with abdominal tuberculosis such as chest radiography and PPD are not so sensitive in detection of abdominal tuberculosis, but computed tomographic scan, and double-contrast barium enema examination may be the most useful radiographic study. Laparotomy with tissue biopsy for smear and culture is the most sensitive and specific diagnostic procedure in suspicious patients.