Abdominal tuberculosis in children.
BACKGROUND
Abdominal tuberculosis (TB) includes infection of the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. The most common forms of abdominal TB in children are adhesive peritonitis and nodal disease.


METHODS
We report our experience with abdominal TB treated in our hospital from 1995 to 2008.


RESULTS
Thirteen patients (3 boys and 10 girls) of mean age 9.8 years were diagnosed as having abdominal TB. Eight patients presented with abdominal distension and abdominal pain. Fever was seen in 4 patients. One patient had surgical abdominal pain and 2 had abdominal mass. Two patients had coexisting pleural effusion and 1 of them had multifocal TB. Abdominal TB involved peritoneum in 9, abdominal lymph nodes in 7, gastrointestinal tract in 3, spleen in 2 patients, and liver in 1. Ascitic fluid analysis of 9 patients showed exudative fluid with predominately lymphocytes. Laparotomy was performed in 3 patients. The diagnosis of abdominal TB was confirmed histopathologically in 5 patients and microbiologically in 3. The remaining patients had been diagnosed by ascitic fluid diagnostic features, abdominal imaging, tuberculin skin test, history of exposure, and a positive response to antituberculous treatment. Twelve patients completed the antituberculous therapy without any complications. One patient with multifocal TB had neurological sequelae.


CONCLUSIONS
In the areas with a high prevalence of tuberculosis and confirmatory investigations are inadequately available, treatment may be initiated, based on strong clinical diagnosis and supportive investigations. In such situations, it is the response to therapy that indirectly proves the diagnosis.
Tinsa
Faten
F
Department of Pediatrics B, Children's Hospital of Tunis, Tunis, Tunisia. faten.tinsa@hotmail.fr
Essaddam
Leila
L
Fitouri
Zohra
Z
Brini
Ines
I
Douira
Wiem
W
Ben Becher
Saida
S
Boussetta
Khadija
K
Bousnina
Souad
S
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology; D002648:Child; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000382:microbiology / Q000473:pathology*; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology*; D008214:Lymphocytes; D008297:Male; D009169:Mycobacterium tuberculosis; D010537:Peritoneum / Q000382:microbiology / Q000473:pathology*; D013154:Spleen / Q000382:microbiology / Q000473:pathology*; D014376:Tuberculosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*
D000995:Antitubercular Agents