title: Tuberculosis: experience in a low endemic area Australian tertiary hospital.
abstract: BACKGROUND
  Abdominal tuberculosis (ATB) poses a significant diagnostic, management, and resource challenge. In Australia, an increasing number of tuberculosis (TB) cases are being reported, and we describe our experience of ATB in an Australian tertiary institution.
  
  
  METHODS
  All diagnosed cases of tuberculosis (TB) at the Royal North Shore tertiary hospital campus of the University of Sydney are entered prospectively into a central registry. Cases of ATB encountered between September 1991 and November 2011 were identified and retrospectively reviewed.
  
  
  RESULTS
  In all, 841 cases of TB were identified, of which 20 were abdominal (2.4 %). Median age at presentation was 34 years (range: 22-79 years), and 55 % of patients were women. None of the patients were born in Australia and 11 patients were of South Asian origin. The most common presenting symptom was abdominal pain (65 %). Diagnosis was based primarily on histology (90 % sensitivity), and the sensitivity of PCR analysis in this series was low (44 %). Eleven of the patients required laparoscopy or laparotomy. 40 % of cases involved the peritoneum, and disease was also seen in solid organs (liver, spleen, pancreas, adrenal gland) and bowel (esophagus, small bowel, colon).
  
  
  CONCLUSIONS
  In our local experience ATB was seen exclusively in the immigrant population. The presentation of ATB varies greatly, necessitating a high index of suspicion within the context of abdominal symptoms in high-risk groups. The role of surgical involvement is indispensable for both diagnosis and management of ATB-related complications. Surgeons should remain mindful of the diagnosis in an age of increasing worldwide incidence.
authors: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, Pacific Highway, St Leonards, NSW 2065, Australia. preet.gill02@gmail.com
authors: Preetjote
authors: P
authors: Gill
authors: Nicholas R
authors: NR
authors: Coatsworth
authors: Justin S
authors: JS
authors: Gundara
authors: Thomas J
authors: TJ
authors: Hugh
authors: Jaswinder S
authors: JS
authors: Samra
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010348:Patient Care Team; D014395:Peritonitis, Tuberculous / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014386:Tuberculosis, Hepatic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014400:Tuberculosis, Splenic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014401:Tuberculosis, Urogenital / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
chemical_list: D000995:Antitubercular Agents
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