Clinical, Imaging, and Endoscopic Profile of Patients with Abdominal Tuberculosis
07 August 2019 (online)
Aims: The aim is to study the clinical, imaging, and endoscopic profile of patients with abdominal tuberculosis (TB) in a tertiary care center.
Subjects and Methods: This was a prospective observational study conducted at Meenakshi Medical College Hospital, Kancheepuram, over a 3-year period, from March 2011 to February 2014. A total of 76 patients were diagnosed with abdominal TB based on their clinical, pathological, endoscopic, and radiological features. A meticulous history and physical examination with complete blood count, human immunodeficiency virus (HIV) status, chest X-ray, ultrasound abdomen, upper endoscopy, and colonoscopy was performed. Barium study, ascitic fluid analysis, and contrast-enhanced computed tomography of the abdomen and pelvis with peritoneal biopsies where need be were also obtained. All the patients received antituberculosis treatment (ATT) under close surveillance and monitoring.
Results: The total number of patients enrolled in our study was 76 with age ranging from 18 to 75 years; 40 were male and 36 were female. There was a significant overlap of symptoms, and most of the patients presented with a multitude of complaints. Abdominal pain was the most common complaint noted in 70 patients, followed by loss of appetite and weight loss in 52, fever in 48, constipation in 28, abdominal distention in 14, and diarrhea in 6 patients. Two patients presented with acute intestinal obstruction requiring emergency surgical intervention. Fever was the most common finding followed by anemia, ascites, abdominal tenderness, and a palpable abdominal mass. A history of pulmonary Koch's was elicited in 28 patients, and 17 had defaulted on treatment. All the patients enrolled in our study received ATT although six were lost to follow-up.
Conclusions: Abdominal TB can present with a myriad of signs and symptoms, and early diagnosis and treatment are the keys for an effective cure and for reducing the morbidity and mortality from this chronic granulomatous disease.
- 1 Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004; 120 (04) 316-353
- 2 World Health Organization, Global Tuberculosis Report 2013. Geneva, Switzerland: World Health Organization; 2013
- 3 Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993; 88 (07) 989-999
- 4 Vij JC, Malhotra V, Choudhary V, Jain N, Prasad G, Choudhary A. et al. A clinicopathological study of abdominal tuberculosis. Indian J Tuberc 1992; 39: 213-220
- 5 Gulati MS, Sarma D, Paul SB. CT appearances in abdominal tuberculosis. A pictorial essay. Clin Imaging 1999; 23 (01) 51-59
- 6 Mukewar S, Mukewar S, Ravi R, Prasad A, S. DuaK. Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Transl Gastroenterol 2012; 3: e24
- 7 Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004; 120 (04) 305-315
- 8 Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol 1977; 67 (04) 324-337
- 9 Tandon RK, Sarin SK, Bose SL, Berry M, Tandon BN. A clinico-radiological reappraisal of intestinal tuberculosis—changing profile?. Gastroenterol Jpn 1986; 21 (01) 17-22
- 10 Makharia GK, Srivastava S, Das P. et al. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol 2010; 105 (03) 642-651
- 11 Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol 2006; 12 (39) 6371-6375
- 12 Horvath KD, Whelan RL. Intestinal tuberculosis: return of an old disease. Am J Gastroenterol 1998; 93 (05) 692-696
- 13 Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002; 12 (02) 312-323
- 14 Suri S, Gupta S, Suri R. Computed tomography in abdominal tuberculosis. Br J Radiol 1999; 72 (853) 92-98
- 15 Steele MA, Burk RF, DesPrez RM. Toxic hepatitis with isoniazid and rifampin. A meta-analysis. Chest 1991; 99 (02) 465-471
- 16 Schaberg T, Rebhan K, Lode H. Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur Respir J 1996; 9 (10) 2026-2030
- 17 Garg PK, Tandon RK. Antituberculosis treatment induced hepatotoxicity. In: Sharma SK, Mohan A. eds. Tuberculosis. 2nd ed.. New Delhi, India: Jaypee Brothers Medical Publishers; 2009: 783-795
- 18 Wagner TE, Huseby ES, Huseby JS. Exacerbation of Mycobacterium tuberculosis enteritis masquerading as Crohn's disease after treatment with a tumor necrosis factor-alpha inhibitor. Am J Med 2002; 112 (01) 67-69