150 Abdominal Tuberculosis in the 21st Century in Peru: A Description of 22 Cases

Abstract

INTRODUCTION: The diagnosis of abdominal tuberculosis (AT) remains complicated, although it's a common pathology in developing countries. A high degree of clinical suspicion is always needed in order to ensure its rapid detection. We aimed to describe and analyze the epidemiological, clinical and radiological features of patients diagnosed with abdominal tuberculosis: tuberculous lymphadenopathy, gastrointestinal, visceral and peritoneal tuberculosis (TB). METHODS: A prospective study was conducted between 2015 and 2016 and patients diagnosed with AT based on clinical, endoscopic and histopathologic features were collected. The clinical, epidemiological and radiological features were described by frequencies and percentages and then analyzed in Stata 12 to evaluate the associations between them. RESULTS: A total of 22 patients were included: 17 males (77%) with a mean age of 38.6 years. Twelve patients (55%) had only one type of AT and 10 patients (45%) had more than one. The most common diagnosis was gastrointestinal TB (14 cases, 64%), followed by peritoneal TB (10 cases, 45%), tuberculous lymphadenopathy (8 cases, 36%) and visceral TB (2 cases, 9%). The former showed 6 presentations: ileocecal (8 cases, 57%), colorectal (7 cases, 50%), duodenal (3 cases, 21%), gastric (2 cases, 14%), esophageal (1 case, 7%) and jejunal (1 case, 7%). The most important antecedents were HIV infection (11 cases, 52%), TB contact (9 cases, 43%) and pulmonary TB and alcoholism (7 cases, 33% each one). The most common symptoms were abdominal pain and weight loss (19 cases, 90% each one), anorexia (17 cases, 81%), fever (15 cases, 71%), nocturnal sweating (13 cases, 62%), chronic diarrhea (12 cases, 57%), cough (11 cases, 52%) and abdominal distension (11 cases, 52%). The physical findings were ascites (8 cases, 38%) and hepatosplenomegaly (5 cases, 24%), and the principal complication was lower gastrointestinal bleeding (5 cases, 24%). Radiological findings consistent with pulmonary tuberculosis were also common (13 cases, 62%). Only abdominal distention and ascites showed statistical association with peritoneal tuberculosis (Fisher's exact = 0.0001 and 0.008 respectively). CONCLUSION: Abdominal pain, B symptoms and chronic diarrhea are the most important manifestations of AT. Hence attention must be paid in patients with this symptoms, especially if they are immunocompromised. In these subjects abdominal distension and ascites seem to suggest the diagnosis of peritoneal TB.