Management of abdominal tuberculosis in a community-based hospital in a high-income developing country

Abstract

Background The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates. Methods All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died. Conclusions Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.

Pulmonary and intestinal tuberculosis with COVID-19 complicated with fluidopneumothorax and colovesical fistula: The importance of diagnosis complexity in line with clinical setting

“…The regimen for intestinal TB treatment was the same recommended regimen as for pulmonary TB [ 6 , 17 , 18 ]. Anti-TB drugs should be prescribed in full doses to complete the treatment, while surgery is the second option to treat intestinal TB with complications [ 27 , 28 ].…”

Totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation: The first case report in worldwide literature with a brief review

“…The treatment is primary pharmacological, but surgical intervention is needed when complications occur or when the diagnosis is uncertain. It is reported that 20%–40% of abdominal tuberculosis cases present acutely and need emergency surgery ( 35 – 37 ). Surgeries performed include radical resections, enteroenterostomy or ileotransverse anastomosis ( 12 ), and conservative surgeries, such as strictureplasty and adhesiolysis ( 38 ).…”

“…The use of laparoscopy in the treatment pathway of patients with suspected abdominal TB is described in a few articles, even though neither small bowel perforation nor totally laparoscopic anastomosis was reported. Mousa et al ( 35 ), in their retrospective study, signaled that five out of thirteen patients with abdominal TB requiring surgical intervention were treated with laparoscopy and three were converted to open surgery. Entirely performed laparoscopic surgeries comprised only cholecystectomy and diagnostic biopsy.…”