Abdominal tuberculosis

Abdominal Tuberculosis is a form of tuberculosis that affects the gastrointestinal tract, peritoneum, lymph nodes, and more rarely, the solid organs in the abdomen including the liver, pancreas, and spleen. It is caused by the bacterium Mycobacterium tuberculosis and is considered a form of extrapulmonary tuberculosis (TB), which means it occurs outside of the lungs.

Etiology and Pathogenesis

Abdominal TB results from the spread of Mycobacterium tuberculosis from a primary site, often the lungs, to the abdominal organs. This can occur through the lymphatic system, the bloodstream, or by direct extension from adjacent organs. The disease can present in several forms, including tuberculous peritonitis, intestinal tuberculosis, and lymphadenitis affecting the abdominal lymph nodes.

Clinical Presentation

The symptoms of abdominal tuberculosis can be nonspecific and may include abdominal pain, weight loss, fever, and night sweats. In cases of intestinal tuberculosis, patients may experience diarrhea, constipation, and intestinal obstruction. Tuberculous peritonitis may present with ascites and abdominal tenderness.

Diagnosis

Diagnosis of abdominal tuberculosis can be challenging due to its nonspecific symptoms and the variety of its manifestations. It often involves a combination of medical history, physical examination, laboratory tests, imaging studies, and endoscopy. Laboratory tests may show signs of inflammation and infection, such as elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Imaging studies, including ultrasound, CT scan, and MRI, can reveal abnormalities in the abdomen but are not specific for TB. Endoscopy, along with biopsy and microbiological culture, can provide a definitive diagnosis by detecting the presence of Mycobacterium tuberculosis.

Treatment

The treatment of abdominal tuberculosis involves a prolonged course of antituberculosis drugs, typically lasting at least 6 months. The standard regimen includes isoniazid, rifampicin, pyrazinamide, and ethambutol. Surgical intervention may be necessary in cases of intestinal obstruction or when complications such as abscesses or fistulas develop.

Prevention

Prevention of abdominal tuberculosis is primarily through the control and treatment of pulmonary TB, which is the most common source of Mycobacterium tuberculosis infection. BCG vaccine provides some protection against TB, though its effectiveness against extrapulmonary forms of the disease is variable.

Epidemiology

Abdominal tuberculosis is more common in regions with high prevalence of pulmonary tuberculosis, such as parts of Asia, Africa, and Eastern Europe. It can affect individuals of any age but is more frequent in young adults.

Complications

Complications of abdominal tuberculosis may include intestinal obstruction, malabsorption, perforation of the intestines, and the formation of fistulas. Chronic inflammation can lead to scarring and strictures in the intestines.

Prognosis

With timely and appropriate treatment, the prognosis for abdominal tuberculosis is generally good. However, delayed diagnosis and treatment can lead to complications and a worse outcome.