Bevin James, Dalton Simon, Wakeman Chris, Perry Will
House Officer, Auckland City Hospital, Auckland.
Infectious Diseases Physician, Christchurch Hospital, Christchurch.
N Z Med J. 2018 Apr 13;131(1473):48-52.
Abdominal tuberculosis presents with non-specific symptoms, including generalised abdominal pain. Prompt and accurate diagnosis is critical to improving outcomes and avoiding complications. We conducted a retrospective review of cases of abdominal tuberculosis presenting to Christchurch Hospital to explore the epidemiology, clinical features and diagnostic modalities used.
Cases were identified by searching for relevant ICD discharge codes from January 1996 to January 2016. Data on age, clinical presentation, investigations and microbiological results were obtained.
There were 20 patients diagnosed with abdominal tuberculosis over the study period. The median age was 34. Thirteen patients were male (65%), seven female (35%). The majority (11) were from Asia (predominantly India), five were African, and three were New Zealand Europeans. Abdominal pain was the most common presenting symptom (70%) followed by fevers (50%) and night sweats (50%). The C-reactive protein was elevated in 15 patients (75%), anaemia was found in 11 (55%) and nine had abnormal liver function tests (45%). Abdominal ultrasound (US) and computed tomography (CT) showed generic inflammatory change in all patients in this series (100%). Laparoscopy was undertaken in 10 (50%) patients, all of which had positive laparoscopic biopsies. Ascitic fluid was obtained in nine, with stains for acid-fast bacilli uniformly negative, however three (33%) had mycobacterial growth from culture. Six colonoscopies were performed: in three (50%) culture and/or histology was positive. Three lymph node biopsies and two formal laparotomies were the remaining diagnostic techniques employed with two biopsies and one laparotomy yielding positive results. Overall, of the 20 cases, 15 (75%) were able to be definitively confirmed, with the remaining five treated presumptively for probable abdominal tuberculosis.
Abdominal tuberculosis is an uncommon presentation at our institution, with an average of one case each year. The typical patient was a young immigrant from Asia or Africa. Diagnostic laparoscopy was the most common and uniformly reliable means of obtaining a definitive diagnosis.
腹部结核表现为非特异性症状，包括全腹痛。及时准确的诊断对于改善预后和避免并发症至关重要。我们对克赖斯特彻奇医院收治的腹部结核病例进行了回顾性研究，以探讨其流行病学、临床特征和所采用的诊断方式。
通过检索1996年1月至2016年1月期间相关的国际疾病分类（ICD）出院编码来确定病例。获取了患者的年龄、临床表现、检查及微生物学结果等数据。
在研究期间共诊断出20例腹部结核患者。中位年龄为34岁。13例为男性（65%），7例为女性（35%）。大多数患者（11例）来自亚洲（主要是印度），5例来自非洲，3例为新西兰欧洲人。腹痛是最常见的症状（70%），其次是发热（50%）和盗汗（50%）。15例患者（75%）C反应蛋白升高，11例（55%）有贫血，9例（45%）肝功能检查异常。本系列所有患者（100%）的腹部超声（US）和计算机断层扫描（CT）均显示有一般性炎症改变。10例（50%）患者接受了腹腔镜检查，所有患者腹腔镜活检均为阳性。9例患者获取了腹水，抗酸杆菌染色均为阴性，但3例（33%）培养出分枝杆菌。进行了6次结肠镜检查：3例（50%）培养和/或组织学检查呈阳性。其余诊断技术包括3次淋巴结活检和2次正式剖腹手术，其中2次活检和1次剖腹手术结果为阳性。总体而言，20例病例中，15例（75%）得以确诊，其余5例按可能的腹部结核进行了推定治疗。
腹部结核在我们医院是一种不常见的疾病表现，平均每年1例。典型患者为来自亚洲或非洲的年轻移民。诊断性腹腔镜检查是获得确诊的最常见且一致可靠的方法。
