Yhoshu Enono, Garnaik Deepak K, Kashiv Soumya, Bhat Nowneet, Piplani Rajat, Prasad Amber, Ahmed Intezar, Balija Satya Sree
Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Pediatric Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2025 Aug 19;17(8):e90491. doi: 10.7759/cureus.90491. eCollection 2025 Aug.
Aims Abdominal tuberculosis (TB) continues to be a common and challenging abdominal disease in children, with a nonspecific clinical presentation and poor outcomes in delayed diagnosis and complicated cases. We aimed to prospectively evaluate the clinical features and diagnostic workup of children with suspected abdominal TB, with a focus on early initiation of medical and surgical treatment and monitoring of therapeutic outcomes. Materials and methods A time-bound prospective observational study of all patients ≤ 17 years requiring admission with symptoms suggestive of abdominal TB from February 2020 to May 2023 was conducted. All necessary routine blood tests and imaging were done, and endoscopies and surgeries as needed by the patient were carried out. The data of the patients who were diagnosed as abdominal TB - probable or definitive - were analyzed. Results Forty-seven patients were recruited with a suspected diagnosis of abdominal TB. Thirty-four patients (24 females and 10 males) were diagnosed as abdominal TB - definite in 18/34 patients (52.94%) and probable in 16/34 patients (47.06%). The mean age was 12.20 ± 3.82 years (4-17 years). Median duration of the symptoms was three months (IQR = 1-5 months). The commonest symptoms were abdominal pain (94.11%), fever (73.52%), and loss of appetite and weight (70.58%). Twelve patients (35.29%) gave a positive history of contact with TB. There were 13/34 (38.23%) patients who had concomitant pulmonary and abdominal TB, and 21/34 (61.76%) patients who had only abdominal TB. Mantoux tuberculin skin test was performed in 20 patients, of which 9/20 (45%) were positive. A Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) was performed in 30/34 patients (88.23%) from fluid or tissue samples, of which 11 patients (35.48%) showed CBNAAT positivity. Fifteen patients (44.11%) underwent surgery, 12 for intestinal perforation and three for intestinal obstruction. Out of the 18 definite cases of abdominal TB, 11/18 (61.111%) were CBNAAT positive, and 10/18 (55.55%) had histopathology suggestive of TB. The 16 probable cases of abdominal TB had a strong history and imaging suggestive of TB abdomen. A total of seven patients who underwent surgery for intestinal perforation expired. One patient developed a relapse, and four patients developed drug-induced liver injury (DILI). Conclusion Abdominal TB remains a common cause of acute abdomen in the pediatric population, often presenting with non-specific features and lacking a definitive diagnostic modality. Early detection through recognition of common clinical features, guided imaging, and timely sampling for confirmation is vital for initiating antitubercular therapy (ATT) and improving outcomes in abdominal TB.
目的 腹部结核病（TB）在儿童中仍然是一种常见且具有挑战性的腹部疾病，临床表现不具有特异性，延迟诊断和复杂病例的预后较差。我们旨在前瞻性评估疑似腹部结核患儿的临床特征和诊断检查，重点关注早期开始药物和手术治疗以及监测治疗效果。
材料和方法 对2020年2月至2023年5月期间所有≤17岁因疑似腹部结核症状而需要入院的患者进行了一项有时间限制的前瞻性观察研究。进行了所有必要的常规血液检查和影像学检查，并根据患者需要进行了内镜检查和手术。对被诊断为可能或确诊腹部结核的患者数据进行了分析。
结果 招募了47例疑似腹部结核的患者。34例患者（24例女性和10例男性）被诊断为腹部结核——确诊18例（52.94%），可能16例（47.06%）。平均年龄为12.20±3.82岁（4 - 17岁）。症状的中位持续时间为3个月（四分位间距 = 1 - 5个月）。最常见的症状是腹痛（94.11%）、发热（73.52%）以及食欲不振和体重减轻（70.58%）。12例患者（35.29%）有结核病接触史阳性。34例患者中有13例（38.23%）同时患有肺结核和腹部结核，21例（61.76%）仅患有腹部结核。对20例患者进行了结核菌素皮肤试验，其中9/20（45%）为阳性。对34例患者中的30例（88.23%）进行了基于 cartridge 的核酸扩增试验（CBNAAT），从体液或组织样本中检测，其中11例患者（35.48%）CBNAAT呈阳性。15例患者（44.11%）接受了手术，12例因肠穿孔，3例因肠梗阻。在18例确诊的腹部结核病例中，11/18（61.11%）CBNAAT呈阳性，10/18（55.55%）组织病理学提示为结核。16例可能的腹部结核病例有强烈的病史和影像学提示腹部结核。共有7例因肠穿孔接受手术的患者死亡。1例患者复发，4例患者发生药物性肝损伤（DILI）。
结论 腹部结核仍然是儿童急性腹痛的常见原因，通常表现为非特异性特征且缺乏明确的诊断方法。通过识别常见临床特征、引导性影像学检查以及及时采样进行确诊以早期发现对于启动抗结核治疗（ATT）和改善腹部结核的预后至关重要。
