Unusual presentations of abdominal tuberculosis.

OBJECTIVE

To review unusual presenting features and diagnostic difficulties of abdominal tuberculosis in an endemic region.

DESIGN

Retrospective clinical study from 1984 to 1989, illustrated by case reports.

SETTING

A single hospital in Kuwait.

PATIENTS: Fifty patients with abdominal tuberculosis established by the standard histologic and bacteriologic demonstration of acid-fast bacilli or tuberculous granulomas.

MAIN OUTCOME MEASURES: Site of disease and unusual features at presentation.

RESULTS

Tubercular lesions are most commonly seen in the ileocecal region. They are also common in the ileum but are less common in the appendix and jejunum. Involvement of the ascending colon, rectum and upper gastrointestinal tract is rare. Abdominal tuberculosis presents in many ways depending on the degrees of ulceration, fibrous healing, infection and caseating abscess formation.

CONCLUSIONS

Abdominal tuberculosis should be considered in immigrants from regions where this disease is endemic who present with abdominal signs and symptoms. Imaging studies, endoscopy and laparoscopy may preclude laparotomy for the diagnosis of abdominal tuberculosis. Antituberculosis chemotherapy is the mainstay of treatment.