title: Abdominal Tuberculosis: A Diagnostic Dilemma.
abstract: BACKGROUND
  Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management.
  
  
  OBJECTIVE
  To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment.
  
  
  METHODS
  A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases.
  
  
  RESULTS
  Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put on anti-tubercular treatment and majority showed good response to therapy.
  
  
  CONCLUSIONS
  Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. Study of histopathological findings can aid in the diagnosis in the settings where advanced molecular methods of diagnosis are not available, leading to early diagnosis and management.
authors.affiliation: Associate Professor, Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre , Moradabad, India .
authors.forename: Seema
authors.initials: S
authors.lastname: Awasthi
authors.affiliation: Assistant Professor, Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre , Moradabad, India .
authors.forename: Manoj
authors.initials: M
authors.lastname: Saxena
authors.affiliation: Assistant Professor, Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre , Moradabad, India .
authors.forename: Faiyaz
authors.initials: F
authors.lastname: Ahmad
authors.affiliation: Assistant Professor, Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre , Moradabad, India .
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Professor, Department of Pathology, Teerthanker Mahaveer Medical College & Research Centre , Moradabad, India .
authors.forename: Shyamoli
authors.initials: S
authors.lastname: Dutta
keywords: Gastrointestinal; Histopathology; Intestinal obstruction; Langhans