Abdominal tuberculosis: a retrospective review of cases presenting to a UK district hospital.
BACKGROUND
Peterborough has one of the highest rates of tuberculosis in the East of England; ∼40% of TB treated locally is extra-pulmonary.


OBJECTIVE
All adults diagnosed with abdominal tuberculosis (ATB) between January 2008 and September 2011 in Peterborough Hospitals were retrospectively evaluated with regard to their clinical history, investigation, management and outcomes.


RESULTS
In total, 17 patients diagnosed with ATB were reviewed. All the patients were from (or descended from) high-risk ethnic groups. Four had co-existing pulmonary TB. Intestinal and peritoneal TB were the most common findings. The most common clinical manifestations included abdominal pain (71%), weight loss (59%), diarrhoea (47%) and pyrexia (41%). Fifteen patients had samples sent for microbiological investigation; 1 (6%) was smear positive and 9 (53%) were culture positive. Two (12%) were isoniazid resistant. No rifampicin resistance was detected. Anti-tuberculous therapy was given for 6-12 months. In total, 16 (94%) patients completed the treatment; 1 patient died prior to regime completion (crude mortality: 6%). There was one reported case of pyrazinamide intolerance and two episodes of isoniazid intolerance.


CONCLUSIONS
ATB is a diagnostic challenge, especially in absence of lung involvement. It mimics other diseases and clinical presentation is usually non-specific, which may lead to diagnostic delay and development of complications. Extreme vigilance should be used when dealing with unexplained abdominal symptoms to ensure timely diagnosis of ATB. Early diagnosis with early anti-tuberculous therapy and surgical treatment are essential to ensure as positive an outcome as possible.
Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK.
J P
JP
Mamo
S O
SO
Brij
D A
DA
Enoch
D015746:Abdominal Pain / Q000382:microbiology; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D003967:Diarrhea / Q000382:microbiology; D004739:England / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000382:microbiology; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D014395:Peritonitis, Tuberculous / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D014386:Tuberculosis, Hepatic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D015431:Weight Loss; D055815:Young Adult
D000995:Antitubercular Agents