title: Paediatric abdominal tuberculosis in developed countries: case series and literature review.
abstract: OBJECTIVE
  To provide an insight into the presentation, diagnosis and management of paediatric abdominal tuberculosis (TB) in developed countries.
  
  
  METHODS
  The records of all children at the Montreal Children's Hospital (MCH) admitted with abdominal TB between 1990 and 2014 were reviewed. An automated and manual literature search from 1946 to 2014 was performed.
  
  
  RESULTS
  (1) CASE SERIES: six cases were identified at the MCH. All were male between 5 and 17 years of age. All were from populations known to have high rates of TB (aboriginal, immigrant). Three underwent major surgical interventions and three underwent ultrasound (US) or CT aspiration or biopsy for diagnosis. (2) LITERATURE REVIEW: 29 male (64%) and 16 female subjects (36%) aged between 14 months and 18 years were identified, including the MCH patients. All patients except one were from populations with a high incidence of TB. Most presented with a positive tuberculin skin test (90%), abdominal pain (76%), fever (71%) and weight loss (68%). On imaging, 22 (49%) were classified with gastrointestinal TB with colonic wall irregularity (41%) and 19 (42%) with peritoneal TB with ascites (68%). A positive culture was obtained in 33 (73%) patients. Three cases used CT- or US-guided aspiration or biopsy to obtain tissue samples. A surgical intervention was performed in 34 (76%) children; 13 (38%) of these were for diagnosis.
  
  
  CONCLUSIONS
  Diagnosis based on clinical features (abdominal pain, fever and weight loss) and CT- or US-guided aspiration or biopsy may encourage physicians to adopt a more conservative approach to abdominal TB.
authors.affiliation: McGill University, Montreal, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Delisle
authors.affiliation: Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.
authors.forename: Jade
authors.initials: J
authors.lastname: Seguin
authors.affiliation: Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Zeilinski
authors.affiliation: Division of Infectious Diseases, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Moore
mesh_terms: D000005:Abdomen; D015746:Abdominal Pain / Q000175:diagnosis; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D005260:Female; D005334:Fever / Q000175:diagnosis; D006801:Humans; D008297:Male; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000628:therapy; D015431:Weight Loss
keywords: abdominal tuberculosis; case series; pediatrics