Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum.

BACKGROUND

Abdominal tuberculosis has varied presentation and can be confused with other conditions.

METHODS

We report our experience with 46 patients. Charts of patients managed during 1984-97 were reviewed.

RESULTS

Fifty-two percent were women and mean age was 46 years. Presenting symptoms were as follows: fever 70%; abdominal pain 70%; weight loss 68%; abdominal swelling 67%; change in bowel habit 39%; anorexia 30%; and sweating 30%. Common physical signs were as follows: fever 73%; ascites 61%; abdominal mass 13%; and doughy abdomen 9%. Thirty percent of patients either gave past history of TB or presented with active TB of other sites. TB skin test was positive in only 27% of patients. CT scans of abdomen were abnormal in 80%, showing ascites, peritoneal lesions or enlarged nodes. Ascitic fluid was diagnostic for TB on smear/culture in 33%. Peritoneal biopsy was performed by laparoscopy or laparotomy in 61%. It was positive for ganulomas in 97% and for smear/culture in 68%. Forty-two patients recovered after receiving anti-TB therapy for 9-12 months. Four patients died. One died within 1 month of initiation of therapy due to extensive TB, and death in the other 3 was due to unrelated causes.

CONCLUSION

Abdominal TB should be suspected in patients with fever, abdominal pain and ascites. This condition carries good prognosis if promptly diagnosed and treated.