Abstract
Background
Abdominal tuberculosis (ATB) is often diagnosed late. Culture confirmation rates are low. Various other diagnostic modalities are used to support treatment decisions.
Methods
We conducted a retrospective study of 50 consecutive patients with ATB managed at a London tertiary centre from 2009-2012. Patient demographics, site of ATB, details of confirmation of TB diagnosis and treatment were recorded.
Results
Of 50 patients, 46% were male. Mean age at diagnosis was 37.7 years (range 11-73). 90% were not UK born, 64% (32/50) from Bangladesh/India/Pakistan. Of all patients, 10% had confirmed HIV. 30% had coexisting pulmonary TB.
Peritoneal involvement was present in 52% of all ATB. Radiological evidence of ATB was found in 81%. Ascites was sampled in 46% and was culture positive in 23%. Laparoscopy was performed in 58% of cases. 88% patients had histology positive for granulomatous inflammation; 46% had positive cultures of biopsy tissue. Average treatment time of peritoneal TB was 7.3 months.
Intestinal TB comprised 28% of all ATB, mostly involving small bowel (10/14) but also oesophagus, stomach, appendix and colon. 50% had concurrent peritoneal involvement. Granulomatous changes were seen in 85%; 43% were culture positive. Average treatment duration was 7.6 months.
Isolated ATB lymphadenitis was seen in 12%, biopsied in 2 of 6, both positive for histology and culture. Another 2 of the 6 were culture positive on bronchoalveolar lavage.
Perineal/perianal TB was seen in 5 cases (culture confirmed in 3). Average treatment in this group was significantly longer than for ATB involving other sites (10 vs 7.3 months, p=0.04).
Conclusions
Laparoscopic biopsy should be performed if possible. Treatment times often exceed 6 months.
- © 2014 ERS