The document provides an overview of abdominal tuberculosis, including its definition, history, causative agent, epidemiology, routes of transmission and pathogenesis, classification, investigations, management, and rare types. Some key points include:
- Abdominal tuberculosis refers to tuberculosis infection of the gastrointestinal tract, mesenteric lymph nodes, peritoneum, and solid organs related to the GI tract.
- It is caused by Mycobacterium tuberculosis and is most commonly seen in the ileocecal region.
- Presentations can include abdominal pain, mass, fever, and constitutional symptoms. Investigations include hematological and radiological tests.
- Types include intestinal, peritoneal, tuberculosis of the mesentery and lymph
2. SCOPE OF PRESENTATION
DEFINITION
HISTORY
AGENT
EPIDEMIOLOGY
ROUTES OF TRANSMISSION &
PATHOGENESIS
CLASSIFICATION
INVESTIGATIONS
MANAGEMENT
RARE TYPES OF GI
TUBERCULOSIS
TB IN HIV & PREGNANCY
3. DEFINITION
The term abdominal tuberculosis refers to tuberculous infection of
the gastrointestinal tract, mesenteric lymph nodes, peritoneum
and omentum, and of solid organs related to the gastrointestinal
tract such as the liver, spleen and pancreas.
4. HISTORY
Tuberculosis was first recognised in Fourth century
BC
Hippocrates described a condition resembling
tuberculosis in a patient with pulmonary lesions and
intestinal disease
Charles Dickens (1812-70) described TB as:
“Dreaded disease in which there is a gradual and
quiet struggle between soul and body where
mortal part whithers away grain by grain and get
wasted”
Major cause of intestinal strictures and bowel
obstruction in the 19th century and early part of 20th
century
5. HISTORY
1882 – Identification of the
causative organism,
Mycobaccterium tuberculosis,
by Robert Koch
Formulated Koch’s postulates to
describe the etiology of Cholera
and TB
1998 – complete genetic
sequence of M. tuberculosis
was identified.
6. AGENT
Mycobacterium tuberculosis (90%)
M. bovis (largely eliminated)
The tubercle bacilli is :
Gram positive
Aerobic
Non-motile
Non- spore bearing
Identified by Ziehl- Neelson acid fast differential
staining method (high content of mycolic acid in cell
wall)
Culture of organism is in Lowenstein-Jensen
medium : 04-06 weeks
8. EPIDEMIOLOGY
GLOBAL INCIDENECE:
Among top 10 causes of death globally
2021 – 6.4 million people developed tuberculosis
In 2020 – estimated 1.6 million deaths incl 187,000 with
HIV
1/4th of global population has latent TB infection
Complicated by emergence of MDR
India has 26 per cent of World TB cases
In 2021, TB incidence in India in all forms was
1,933,381 – 19% higher than 2020.
TB declared as notifiable disease by Govt of India on
09 May 2012
World TB day : 24 March
9. EPIDEMIOLOGY
Common in India & developing countries, more
frequently in people of poor socio-economic
background
6th most common type of extrapulmonary TB
following LN, pleura, GU tract, bones/joints and
meninges .
Higher incidence in HIV infected patients : 36% of
AIDS patient develop TB, among which 50 %
develop abdominal TB
11. EPIDEMIOLOGY
Developed countries
Immigrant population
Ageing population
Increase in HIV
Developing countries
Incomplete treatment
MDR strains
Increase in HIV/AIDS
RE-EMERGENCE
12. TRANSMISSION
Ingestion of contaminated food : causing primary
abdominal tuberculosis
Swallowed sputum : containing tuberculous bacteria from
primary pulmonary focus causing secondary abdominal
tuberculosis.
Hematogenous spread: during bateremic phase that may
follow primary TB
Lymphatic spread : from infected nodes (5-10%)
Direct spread :
From Fallopian tubes by retrograde spread to involve peritoneum
(10%)
From adjacent organs
Disseminated in bile : since they are sequestrated and
excreted from granulomas in liver
16. TYPES
1. Intestinal:
Ileocaecal region:
Ulcerative (60 %)
Hyperplastic
Ulcero-hyperplastic
Ileal region: commonly
stricture type
2. Peritoneal
Acute
Chronic:
Ascitic type
Encysted (loculated) type
Plastic (fibrous/adhesive)
Purulent type
3. TB of mesentery and its LN
4. Ano-recto-sigmoidal
5. Involvement of organs:
Liver, spleen and other
forms of miliary TB
6. TB of omentum
7.Rare types:
Oesophageal
Gastroduodenal
Retroperitoneal TB
17. ILEOCAECAL TUBERCULOSIS
Most common site of abdominal TB
Due to:
Stasis : bacterial contact time is more
Abundant Peyer’s patches
Minimal digestive activity
Fluid and electrolyte absorption
Types:
Ulcerative 60%
Hyperplastic
Ulcero-hyperplastic 30%
18. ILEOCAECAL TUBERCULOSIS
Ulcerative
Common in old, malnourished people
Circumferential transverse ulcers – with skip lesions
Long standing ulcers cause fibrosis and later stricture
formation (Napkin- ring structure)
Bowel adhesions are common
Mainly presents with diarrhoea, blood in stool, loss of
appetite and reduced weight.
19. Fig - Ileocaecal Tuberculosis: Note the sites and tubercles
in ileocaecal valve
20. Fig - Histology of ileocaecal tuberculosis showing Epithelioid cell
granuloma with caseation
22. Hyperplastic:
10% common, less virulent
young, well nourished
individual
Fibroblast reaction in
submucosa and subserosa -
thickening of bowel wall and
LN enlargement, leading to
nodular mass
Common in caecal part
ILEOCAECAL TUBERCULOSIS
Note the ileocaecal
tuberculosis with stricture.
23. ILEOCAECAL TUBERCULOSIS
•Causes extensive chronic
inflammation, fibrosis, bowel
adhesions, nodal
enlargement, often presents
with mass in RIF
•When presents as a mass-
SAIO
24. Virulent organism
Poor body resistance, old people
Multiple transverse ulcers
Clinically -diarrhea, bleeding P/R,
loss of appetite and reduced
weight
Complications: stricture, Intestinal
obstruction
Barium study - ileal strictures
Less virulent organism
Good body resistance,
young individuals
Chronic granulomatous
lesion in ileocaecal region
Presents as mass in RIF
Complications: SAIO
Barium study -pulled up
caecum, obtuse ileocaecal
angle
ULCERATIVE HYPERPLASTIC
ILEOCAECAL TUBERCULOSIS
25. Usually stricture type
May be multiple
Presents usually with intestinal obstruction, bowel
adhesions, localisation, fibrosis
Perforation (5%)
ILEAL TUBERCULOSIS
26. Pathology:
Enormous thickening of the
parietal peritoneum with
multiple tiny yellowish
tubercles
Dense adhesions in
peritoneum and omentum
with content inside as small
bowel looking like Abdominal
cocoon (sclerosing
encapsulating peritonitis).
PERITONEAL TUBERCULOSIS
27. ACUTE PRESENTATION
Mimics acute abdomen
On- table diagnosis
Presents with features of peritonitis
Due to perforation or rupture of mesenteric tubercular
LN
PERITONEAL TUBERCULOSIS
28. Photo A-C intraop findigns slide 24
Fig A to C - On-table findings in
intestinal tuberculosis,
of extensive involvement with
multiple tiny tubercles, thickening,
adhesions and involvement of
mesenteric lymph nodes.
29. CHRONIC PRESENTATION
1. Ascitic form (Wet type):
Distension of abdomen with dilated veins.
Ascitic tap reveals straw colored fluid from which AFB
can be isolated.
PERITONEAL TUBERCULOSIS
30. 2. Encysted (Loculated) ascites:
Ascites gets loculated because of the fibrinous
deposition
Dullness, which is not shifting, is the typical feature
May present as intra-abdominal mass, which may
mimic ovarian cyst, retroperitoneal cyst or
mesenteric cyst
PERITONEAL TUBERCULOSIS
31. 3. Plastic type (Dry type):
Widespread adhesions
Present with colicky abdominal pain, diarrhoea, wasting
and loss of weight, doughy abdomen
D/D: Peritoneal carcinomatosis
PERITONEAL TUBERCULOSIS
32. 4. Purulent form:
Invariably due to tuberculous salpingitis
Presents as mass in the lower abdomen containing pus.
Cold abscess gets adherent to abdominal wall, umbilicus
and may form an umbilical fistula
Patient commonly has got genitourinary tuberculosis
PERITONEAL TUBERCULOSIS
33. TUBERCULOUS MESENTERIC LYMPHADENITIS
Infection is usually through the Peyer’s patches
Commonly, right sided LN involved
Presents with general symptoms, pain in umbilical
region and RIF, mass in RIF or features of acute
appendicitis
Often coils of intestine get adherent to the caseated
mesenteric LN leading to intestinal obstruction.
Caseating material may collect between the layers of the
mesentery, forming a cold abscess – pseudomesenteric
cyst.
34. Massive enlargement of mesenteric LN due to TB is
called as Tabes mesenterica
Fig - Note the location of mesenteric tuberculous lymphadenitis in
the right iliac fossa. But it can occur anywhere in the line of
mesentery.
TUBERCULOUS MESENTERIC LYMPHADENITIS
35. Fig A-C: On table finding of
Mesenteric tubercular
lymphadenitis
37. ANO-RECTO-SIGMOIDAL TUBERCULOSIS
It mimics Carcinoma rectum, most
common symptom - hematochezia
Presents as tenesmus, diarrhoea,
discharge from fistula and ocassionally
as mass per abdomen
Fistulas- painful and characteristically
not indurated
TB fistulas -multiple, shallow, bluish in
color with undermined edges.
38. TUBERCULOSIS OF OMENTUM
Usually occurs as a part of the other types
Characteristic finding - Rolled up omentum with
thickening
Often cold abscess can develop.
39. DIFFERENT CLINICAL PRESENTATIONS OF ABDOMINAL
TUBERCULOSIS
Clinical presentation:
Acute
Acute on chronic
Chronic
Common in 25-50 yrs age group, equal in both sexes
Constitutional symptoms:
Anemia, loss of weight & appetite (80%)
Diarrhoea (10-20%)
Fever (50-70%)
Failure to thrive, in children
Overall observed in 30% of the patients
40. CLINICAL PRESENTATIONS
Abdominal Pain
Mass in RIF – may mimic Carcinoma caecum
Other sites of lump:
Central abdomen – enlarged mesenteric LN
Ilioinguinal – Iliopsoas abscess secondary to TB spine
Upper abdomen – rolled up omentum
Lower abdomen – Tubo-ovarian mass
Anywhere in abdomen – colonic TB, loculated ascites,
matted bowel loops
Can be associated with adenocarcinoma of caecum or
large bowel lymphoma or HIV
41. SUMMARY OF SYMPTOMS AS PER TYPES
Types Symptoms
Ulcerative Diarrhoea and malabsorption
Stricture Subacute or acute intestinal obstruction
Hyperplastic Mass abdomen (RIF) and obstruction
Ascites Generalised distension of abdomen
Localised Intra abdominal mass, may mimic ovarian cyst,
retroperitoneal or mesenteric cyst
Peritoneal Abdominal cocoon, vague abdominal pain
Mesenteric Tabes mesenterica, obstruction, mass
Atypical presentation:
Lower GI bleed
Fistula in ano
PID like pain
Gastric disease symptoms, Dysphagia
GI fistula
46. BARIUM MEAL STUDY
Barium study X-Ray (Enteroclysis followed by
barium enema or barium meal follow through)
Series of a barium meal and follow-through showing strictures in the ileum, with the
caecum pulled up into a subhepatic position and obtuse ileocecal angle.
51. Napkin lesions – ulcers &
strictures in the terminal
ileum and caecum
Earliest signs – increased
transit time,
hypersegmentation
(chicken intestine),
flocculation of barium
Mega ileum – multiple
strictures with enormous
dilatation of proximal ileum
Chicken Intestine sign
52. INVESTIGATIONS
USG findings:
Thickened bowel wall, mesentery, omentum, peritoneum
Loculated ascites with fine septae
Interloop ascites with alternate echogenic and echo free
areas – Club sandwich appearance
Club Sandwich appearance
53. USG FINDINGS
Bowel loop radiates from its mesenteric root –
Stellate sign
Mesenteric loop thickness more than 15 mm
Hepatosplenomegaly
LN enlargment, matted
Pulled up caecum presenting as a mass in
subhepatic region – Pseudokidney sign (also seen
in intususception)
Concentric uniform mural thickening
54. CT abdomen:
Very useful and reliable
Findings:
Thickened bowel wall, peritoneum
Ileocecal valve thickening
Enlarged/necrosed/ matted mesenteric nodes,
often with cold abscess
Adhesions
Mesenteric thickening and nodules
Nodules in peritoneum/ solid organs
Adhesions in the bowel/ stricture/ obstructive
features
Loculated ascites
CT guided FNAC / biopsy/ fluid aspiration
INVESTIGATIONS
55.
56. COLONOSCOPY
To rule out CA
Shows mucosal nodules, ulcers,
strictures, deformed ileocecal
valve, mucosal oedema and
diffuse colitis
Biopsy can be taken to establish
diagnosis
Capsule endoscopy : useful to
see small intestinal pathology in
difficult cases due to obstruction
at stricture site.
57. Laparoscopy :
Aids in visualisation
To collect ascitic fluid for analysis
To take biopsy
Blind percutaneous needle peritoneal biopsy
Using Cope’s / Abraham’s needle
Ascitic tap for fluid analysis
BACTEC MGIT broth culture
INVESTIGATIONS
58. NEWER SEROLOGICAL INVESTIGATIONS
IFN gamma release assay (IGRA) : based on
detection of IFN gamma released by sensitied T cells
on stimulation with specific Ags.
T spot TB test – directly count the no. of IFN gamma
secreting T cells
Quantiferon TB Gold in-tube test – measures the
concentration of IFN gamma secretion
Early secretory Antigen Target-6 (ESAT-6) & Culture
filtrate protein-10 (CFP 10):
Both derived from a very specific region of MTb, the region
of difference 1 (RD1). This segment is deleted from all
strains of BCG and the majority of environmental
mycobacteria
Advantage : discriminate between MTb infection and
previous BCG vaccination.
59. Polymerase chain reaction (PCR) – molecular tests for
detection of nucleic acid
Single primer IS6110- Sn 47%, Sp 95%
Multiplex PCR with multiple primer IS6110, 16SrRNA and dev RNA –
Sn 87 for ITB, 76 % for peritoneal TB
NAAT :
Assays amplify M. tuberculosis specific nucleic acid sequences using
a nucleic acid probe
Requires as little as 10 bacilli from given sample
Specificity 98-99%
Major limitation : no drug susceptibility info
Types:
AMPICLOR MTB assay
Amplified Mtb direct (AMTD2) assay
LCx MTB assay, ABBOTT LCx probe system
BD Probe Tec energy transfer (ET) system (DTB)
INNO-LiPA RIF TB assay
16S rRNA gene sequence analysis
60. ASCITIC FLUID
Exudate with protein level >2.5 gm/dl
SAAG <1.1 (Low SAAG ascites)
Sp gravity > 1.016
Glucose < 30 mg
Decreased pH
LDH >90units/litre
Lymphocyte predominant cells with count 250/cumm
AFB in ascitic fluid is seen in only < 3% cases
ADA in ascitic fluid >33 units/ml : 95% specificity, 98%
sensitivity
63. COMPLICATIONS
Obstruction 20%
Malabsorption, blind loop syndrome
Dissemination of tuberculosis to other area of
abdomen as well as extra-abdominal sites
Faecal fistula
Cold abscess formation
Hemorrhage, perforation (rare)
65. MEDICAL
First line of management
ATT
SURGICAL
Refractory cases
Presenting as acute abdomen
TREATMENT
66. UPDATES IN PROTOCOL
Daily regimen instead of thrice weekly doses
Fixed drug combination
Inroduction of Weight bands
Ethambutol continued in continuation phase
No extension of IP
New categories:
Drug sensitive
Drug resistant
68. REGIMEN FOR DRUG SENSITIVE
TUBERCULOSIS
Type of TB case Treatment regimen
in IP
Treatment regimen
in CP
New and previously
diagnosed DS TB
(2) HRZE (4) HRE
69. DAILY DOSE SCHEDULE FOR ADULTS AS PER
WEIGHT BANDS
Weight Category Number of tablets (FDC)
IP
HRZE
(75/150/400/275)
CP
HRE
(75/150/275)
25-34 Kg 2 2
35-49 Kg 3 3
50-64 Kg 4 4
65-75 Kg 5 5
>75 Kg 6 6
70. DRUGS FOR DRUG RESISTANT TUBERCULOSIS
A. Fluoroquinolones
Levofloxacin
Moxifloxacin
Gatifloxacin
B. Second line injectables:
Amikacin
Kanamycin
Streptomycin
C. Other second line agents:
Ethionamide
Cycloserine
Linezolid
Clofazimine
D. Add on agents(Not part of
Core MDR regimen):
D1:
Pyrazinamide
Ethambutol
High dose Isoniazid
D2:
Bedaquiline
Delamanid
D3:
P-aminosalicylic acid
Meropenem
Amoxicillin-clavulanate
Thioacetazone
71. TYPES OF DRUG RESISTANCES
H Mono/Poly drug resistances:
Isoniazid resistance
Isoniazide + one of the first line drug except Rifampicin
MDR:
Isoniazid + Rifampicin resistant
XDR:
Isoniazid + Rifampicin + 2nd line injectable +
Fluoroquinolones
RR:
Rifampicin resistant
72. REGIMEN FOR DRUG RESISTANT TB
Regimen class IP CP
H mono/Poly DR TB (6) Lfx R E Z
MDR/
RR TB
Shorter regimen (9-11) (4-6)
Mfxh
Km/Am
Eto
Cfz
Z
Hh
E
(5)
Mfxh
Cfz
Z
E
Longer regimen (18-20) Bdq(6)
(18-20) Lfx
Lzd#
Cfz
#Lzd dose reduced to 300mg/day after 6 months
77. SURGICAL MANAGEMENT
2. Stricturoplasty:
Single – stricturoplasty / RA (if bowel wall
is oedematous and friable)
Multiple - strictures resection of ileum
and anastomosis is done (ideal). /
Multiple stricturoplasty (If Multiple
strictures with long segment gaps
between each).
Resection is better option for stricture
within 10 cm of ileocaecal valve.
78. SURGICAL MANAGEMENT
If perforation: resection & anastomosis done
In severly contaminated peritoneum, resection and
exteriorisation is done. Bowel continuity is restored after
proper antitubercular therapy and proper nutritional
improvement.
During therapy if patient develops ileocaecal
obstruction, ileotransverse colon anastomosis
(bypass) can be done
Adhesive obstruction may be released through
laparoscopic adhesiolysis
Drainage of intra-abdominal abscess, perianal
abscess and treatment for tuberculous fistula-in-
ano is done when necessary.
79. SURGICAL MANAGEMENT
Management of acute type of peritoneal
tuberculosis:
Exploratory laparotomy – reveals straw colored fluid
with tubercles in the pritoneum, greater omentum and
bowel wall
Fluid is evacuated and collected for AFB study and
culture
Omental biopsy is taken
Abdomen is closed (without a drain) with tension
sutures to prevent burst abdomen and ATD is started.
80. SURGICAL MANAGEMENT
Loculated form of peritoneal tuberculosis:
Fluid aspiration under laparoscopic vision
Purulent form of peritoneal tuberculosis:
ATD
Exploration of umbilicus, exploration of fistula and bowel
bypass.
Prognosis poor
Ano recto sigmoidal tuberculosis:
ATD
Fistulectomy
Often sigmoid resection
82. TB OESOPHAGUS
Mimics Oesophageal CA
Mid esophageal ulcer, dysphagia and
odynophagia, low grade fever
Pathology - extension from nearby tubercular
LN into esophagus
Barium swallow:
Patient with mediastinal lymphadenopathies that
produced a fistula demonstrated by endoscopy
Extensive esophageal ulceration
Extrinsic compression due to lymphadenopathies
83. TB GASTRODUODENUM
0.3-2.3% of patients with pulmonary TB
Uncommon due to :
Acidic environment
Rapid gastric emptying
Paucity of Peyer’s patches
Gatric TB – may mimic Peptic ulcer not relieving to
antisecretory therapy , Gastric CA or sarcoidosis,
syphilis stomach
Present as ulcerative, granulomatous or fibrosing
lesion – may result in GOO
Duodenal TB – obstruction due to extrinsic
compression by LN
84. Other presentations:
Perforation
Fistula
Ulcer excavation into pancreas
Obstructive jaundice due to CBD compression
ATD should be initiated in all patients- curative in
most, especially ulcerative lesions
Surgical intervention is required if GOO persists
despite medical management
Surgical approach – partial gastric resection such
as Bilroth gastrectomy or a sleeve resection
85. JEJUNAL TB
Presents with
Single or multiple strictures
Intestinal obstruction
Perforation (proximal to stricture)
86. SEGMENTAL COLONIC TB
Involvement of colon without ileocaecal region
Involves sigmoid, ascending and transverse colon
Pain and hematochezia is common
87. APPENDICEAL TB
0.1 – 3% of patients with tuberculosis
Isolated TB of appendix is rare
Treatment of choice: Appendectomy followed by
ATD
88. TUBERCULOSIS OF SOLID ABDOMINAL ORGANS
LIVER
Exceedingly rare these days
Usually diagnosed accidentally
during exploration
Typical lesions are
granulomas, with or without
central caseating necrosis,
calcified masses and biliary
strictures
89. TB peritoneal LN may cause obstructive jaundice
due to compression of bile duct
Usually have hepatomegaly, with or without
jaundice
Liver enzymes, particularly ALP, are elevated
D/D: other conditions associated with hepatic
granulomas such as leprosy, Hodgkin disease,
brucellosis, infectious mononucleosis, IBD, syphilis
Treatment : Chemotherapy
Note: most ATT are hepatotoxic (except
ethambutol), hence close observation necessary
90. SPLEEN
Rare
May present as splenic
abscess or hypersplenism
Presence of multiple
hypoechoic lesion on USG
in a HIV patient is highly
suggestive of disseminated
TB
Diagnosis is usually made
following surgical resecion
of the diseased spleen
91. Pancreas:
Like or part of miliary TB
Common in immunocompromised
Usually present as acute or chronic pancreatitis
Pancreatic mass or abscess may develop
Can mimic malignancy
Treatment : ATD
92. TB & HIV
Estimates of TB HIV burden in India ( Global TB report 2021)
HIV positive TB incidence 53000, 3.8%
HIV positive TB mortality 11000, 0.78/lac
People with HIV are 29 times more likely to develop TB
Anti TB regimen and duration is same irrespective of HIV
status
ATT should be started first
ART must be offered to all patients with HIV & TB,
irrespective of CD4 count
ART should be started as soon as TB treatment is
tolerated ( between 2 weeks to 2 months)
93. TB & HIV
Preferred regimen of fixed dose combination:
Tenofovir 300mg
Lamivudine 300 mg
Doltegravir 50 mg
Avoid Nevirapine based regimen due to drug interaction
Immune reconstitution inflammatory syndrome (IRIS) can
occur after ART initiation and requires appropriate
management
Co-trimoxazole prophylaxis has to be ensured to prevent
opportunistic infections
Counselling:
Nature and course of both diseases
Long term treatment and side effects
Cough hygiene
Screening of family members
Safe sexual practices
Abstain from alcohol, smoking & substance abuse
94. TB & PREGNANCY
Diagnostic challenge due to common non-specific
symptoms
May lead to:
Repeated reproductive failures
Fetal ill health
Preterm delivery
TB of the newborn and infants
High maternal and perinatal morbidity and mortality
NTEP and Maternal Health division aims towards
prevention, screening as a part of ANC for early
diagnosis and prompt management
95. TB & PREGNANCY
1st trimester – standard regimen for Drug sensitive
TB
Drug resistant TB – avoid pregnancy
If patient becomes pregnant while on treatment:
<20 weeks <20 weeks
Advised MTP
MTP
Continue Treatment
Unwilling for MTP
Modified regimen
<12 weeks
Omit Km, Eto
Add PAS
>12 weeks
Omit Km only,
Add PAS
Modified regimen
Omit Km, add PAS till delivery
Replace PAS with Km after delivery
and continue till end of IP
96. FOLLOW UP & PROGNOSIS...
Regular weight check to see for gain;
Improvement in appetite;
Reduction of abdominal pain and distension;
Absence of fever;
Normal bowel habits;
Normal haemoglobin;
ESR becoming normal;
US abdomen shows improvement in sonological
features.
Patients who are not responding in 6 weeks
should be reassessed again for—drug resistance;
associated other diseases like malignancy
(carcinomas or lymphoma), Crohn‘s disease,
eosinophilic enteritis.
During therapy patient who is responding for drug
therapy can also go for intestinal obstruction due
to fibrosis during healing stage. It needs surgical
intervention.
97. CHALLENGES
Abdominal TB is a great mimicker
: can mimic infections,
malignancy etc
Can involve single abdominal
organ without pulmonary
involvement, only 15-25% has
concomitant pulmonary TB
Correct clinical diagnosis in only
50%
Diagnostic challenge due to non
specific presentation and delay
leads to complication
Hence, HIGH INDEX OF
SUSPICION required for early
diagnosis
98. TAKE HOME
MESSAGE…
Repeated surgery in abdominal
tuberculosis is difficult and dangerous as
chances of developing faecal fistula,
further adhesions are more likely.
So timely diagnosis, proper
treatment and counselling
to patients is important…
99. REFERNCES
1. Oxford Textbook of Surgery, 2nd ed
2. Harrison’s Principles of Internal Medicine, 19th ed
3. Bailey & Love’s Short Practice of Surgery, 27th ed
