Abdominal tuberculosis
Involvement of any of the following sites: - peritoneum - stomach - intestinal tract - hepatobiliary tree - pancreas - perianal area - lymph nodes.
TB of the abdomen may occur via reactivation of latent TB infection or by ingestion of tuberculous mycobacteri
Types
Peritoneal tuberculosis
- Most commonly following reactivation of latent tuberculous foci in the peritoneum established via hematogenous spread from a primary lung focus
- Can also occur via hematogenous spread in the setting of active pulmonary TB or miliary TB
- As the disease progresses
- The visceral and parietal peritoneum become studded with tubercles
- Ascites develop secondary to exudation of proteinaceous fluid from the tubercles.
- Clinical manifistations
- Ascites
- Abdominal pain
- Fever
- In advance cases, patients present with a “dry” phase with a “doughy” abdomen, which represents a fibroadhesive form of the disease
Intestinal tuberculosis
Two types of bowel lesions are seen:
- Ulcerative
- Ulcerohypertrophic.
Ulcerative and stricturous forms are usually observed in the small intestine, while colonic and ileocecal lesions are usually ulcerohypertrophic. The most common site of involvement is ileocecal area (ranging from 25 to 90 percent across various series), followed by small intestine (6 to 67 percent), colon (2 to 32 percent), and gastroduodenal area (0.5 to 5 percent).
Signs and symptoms in a patient with intestinal TB may include:
- Clinical manifestations reflecting intestinal ulceroconstrictive disease; these include intestinal colic, abdominal distension, chronic diarrhea, nausea, vomiting, constipation, and bleeding.
- Clinical manifestations reflecting adjacent tissue involvement; these include ascites, lymph node enlargement, and tubo-ovarian symptoms.
- Clinical manifestations of chronic inflammation; these include fever, fatigue, weight loss, and night sweats.
Hepatic tuberculosis
There are two presentations of hepatic TB:
- Miliary hepatic disease
- Liver involvement in miliary TB occurs in approximately 80 percent of cases of disseminated TB; in this form, TB reaches the liver via the hepatic artery.
- Isolated hepatic disease.
- Isolated hepatic TB occurs in approximately 20 percent of cases; in this form, TB reaches the liver from the intestinal tract via the portal vein or gastrointestinal lymphatics or may represent reactivation of latent TB infection Clinical presentaion
- Hepatomegaly
- Fever
- Respiratory symptoms
- Abdominal pain
- Weight loss
- Splenomegaly
- Ascites
- Jaundice
Pancreatic tuberculosis
- Pancreatic TB is uncommon.
- It presents with abdominal pain, constitutional symptoms, and jaundice; it must be differentiated from pancreatic malignancy
Diagnosis
- History and clinical examination
- Established by demonstration of Mycobacterium tuberculosis in peritoneal fluid (in the setting of ascites) or a biopsy specimen
Treatment
- Antituberculous therapy
- Surgery for complications