Abstract
BackgroundThe accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis.MethodsBased upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group.ResultsAccording to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003).ConclusionGastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change.
Highlights
The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice
In patients with abdominal TB, the highest incidence of disease was noted in the gastrointestinal tract and in the peritoneum, followed by the mesenteric lymph nodes
In addition to physical examination, basic laboratory studies, and anti-human immunodeficiency virus (HIV) serology, patients admitted with abdominal symptoms including pain, distension, nausea, vomiting, altered bowel habit, weight loss were evaluated for tuberculosis
Summary
The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. Tuberculosis (TB) is rarely seen in western countries, but it is not an uncommon disease in the developing world [1]. TB in its various forms remains an important cause of morbidity and mortality in developing countries and in patients with AIDS [5]. In patients with abdominal TB, the highest incidence of disease was noted in the gastrointestinal tract and in the peritoneum, followed by the mesenteric lymph nodes. The ileocecal area is the most common site of involvement [9]
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