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Video:Abdominal tuberculosis

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Description

Abdominal tuberculosis is a type of extrapulmonary tuberculosis which involves the abdominal organs such as intestines, peritoneum and abdominal lymph nodes. It can either occur in isolation or along with a primary focus (such as the lungs) in individuals with disseminated tuberculosis.[1] PCR and CT scan(of abdomen) may be used for diagnosis.[2] Treatment is with anti-tuberculosis drugs and/or surgery.[2]Higher incidence exists in TB-endemic regions such as South Asia, sub-Saharan Africa, and parts of Latin America.Lack of mandatory organ-specific reporting in EPTB misrepresents the true burden estimates.[3][4]

Types

Medical and radiology sources indicate that abdominal tuberculosis is divided into four main types: tuberculous lymphadenopathy, peritoneal tuberculosis, gastrointestinal tuberculosis, and visceral tuberculosis involving the solid organs.[5]

Presentations

The symptoms of abdominal tuberculosis depends on the sites of involvement, the most common symptoms and signs of abdominal tuberculosis are abdominal pain, and ascites. Other clinical features are fever, altered bowel habits, and loss of weight.[6][2]

Complication

As to complications in the affected individual we find the following may occur: anemia, obstruction of gastrointestinal lumen, lower gastrointestinal bleeding and perforation.[2]

Risk factors

The risk factors for abdominal tuberculosis are immunocompromised states such as HIV infection, diabetes mellitus and underlying malignancy. Liver cirrhosis and use of peritoneal dialysis are also risk factors for abdominal tuberculosis.[7][2][8]

Pathophysiology

There are several ways by which tuberculosis can infect the abdomen. The tubercle bacteria many enter the abdomen via the consumption of infected milk. Those with existing pulmonary tuberculosis can have abdominal tuberculosis through the ingestion of infected sputum.[5] When the gastrointestinal tract is infected with the bacteria, epitheloid tubercles are formed in the lymphoid tissue of the submucosal layer. Subsequently, caseous necrosis of the tubercles can occur, leading to ulceration of the mucosa. At this stage, the bacili can spread to adjacent lymph nodes and deeper layers of the peritoneum.[5]

Diagnosis

The clinical presentation of abdominal tuberculosis is often atypical, tissue samples for confirmation of diagnosis can be difficult to procure and conventional diagnostic methods have poor yield.[1] Therefore, the diagnosis is often delayed.[1] The diagnosis is often suspected clinically with relevant manifestations or epidemiological factors such as known prior tuberculosis and possible TB exposure.[9] A high index of suspicion of TB should be maintained in immunocompromised individuals.[9]

Differential diagnosis

As to the differential diagnosis of abdominal tuberculosis we find the following:[2] esophageal cancer, gastric ulcers, colorectal cancer, hepatic granulomatosis and colitis.

Management 1

Abdominal tuberculosis most often responds to treatment with anti-tuberculosis drugs.[5]Treatment using anti-tuberculous drugs can cause resolution of fever, and ascites a few weeks after the start of the therapy.[9]

Management 2

Surgery may be warranted in abdominal tuberculosis in case of complications such as perforation, abscess, bleeding, fistula or obstruction.[9]There are three types of surgeries usually performed in abdominal tuberculosis. The first type of surgery is to bypass the affected segments of the bowel. The second type is a more extensive surgery called hemicolectomy, where a large portion of the bowel is removed.[5] The third type is stricturoplasty which is done for relieving the luminal obstruction caused due to intestinal tuberculosis.When bowel perforations occur in tuberculosis, it is usually treated by the resection of the involved segments.[5][10]

Prognosis

With treatment, the prognosis is good.Untreated abdominal TB has a mortality rate of 6 to 20 percent and can lead to complications that may require surgical intervention[2]

Epidemiology

Abdominal tuberculosis accounts for up to 5 percent of the tuberculosis cases worldwide.[1][11] It makes up for less than 11 to 15 percent of all tuberculosis cases in immunocompetent individuals.[1]Approximately 20 percent of individuals with abdominal tuberculosis have active tuberculosis. The incidence of abdominal tuberculosis has increased in the last few decades due to the increased incidence of HIV infection, which makes individuals vulnerable to tuberculosis.[12][13][14]

History

Ancient history indicates that symptoms resembling abdominal TB were described in Egyptian, and Chinese texts as early as 2000–3500 years ago.[15]As to recent history Logan and Paustian's postulates in the mid-20th century, helped distinguish abdominal TB from Crohn's disease, which it often mimics.[15]

Research

In terms of research we find molecular methods, particularly those targeting Mycobacterium tuberculosis DNA, remain the most significant area of progress due to their high specificity and turnaround time.A 2022 review indicates the potential of multiplex Polymerase Chain Reaction, which amplifies multiple DNA targets in a single reaction. This technique has shown a superior sensitivity compared to simple PCR or GeneXpert assays for detecting the low bacterial load often found in abdominal TB tissue samples.[16]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Sharma, SK; Mohan, A (October 2004). "Extrapulmonary tuberculosis". The Indian Journal of Medical Research. 120 (4): 316–53. PMID 15520485.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Tobin, Ellis H.; Khatri, Akshay M. (6 February 2025). "Abdominal Tuberculosis". StatPearls [Internet]. StatPearls Publishing. PMID 32310575. Retrieved 31 August 2025.
  3. ↑ Nath, Preetam (2022). "Epidemiology of Gastrointestinal Tuberculosis". Tuberculosis of the Gastrointestinal system. Springer Nature. pp. 9–19. doi:10.1007/978-981-16-9053-2_2. ISBN 978-981-16-9053-2.
  4. ↑ Yang, Huafei; Ruan, Xinyi; Li, Wanyue; Xiong, Jun; Zheng, Yuxin (11 November 2024). "Global, regional, and national burden of tuberculosis and attributable risk factors for 204 countries and territories, 1990–2021: a systematic analysis for the Global Burden of Diseases 2021 study". BMC Public Health. 24 (1): 3111. doi:10.1186/s12889-024-20664-w. ISSN 1471-2458. PMC 11552311. PMID 39529028.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Debi, Uma (2014). "Abdominal tuberculosis of the gastrointestinal tract: Revisited". World Journal of Gastroenterology. 20 (40): 14831–40. doi:10.3748/wjg.v20.i40.14831. PMC 4209546. PMID 25356043.
  6. ↑ Chou, Chia-Huei; Ho, Mao-Wang; Ho, Cheng-Mao; Lin, Po-Chang; Weng, Chin-Yun; Chen, Tsung-Chia; Chi, Chih-Yu; Wang, Jen-Hsian (1 October 2010). "Abdominal Tuberculosis in Adult: 10-Year Experience in a Teaching Hospital in Central Taiwan". Journal of Microbiology, Immunology and Infection. 43 (5): 395–400. doi:10.1016/S1684-1182(10)60062-X. PMID 21075706.
  7. ↑ "Tuberculosis Risk Factors". Tuberculosis (TB). 5 February 2025. Retrieved 10 September 2025.
  8. ↑ Chau TN, Leung VK, Wong S, Law ST, Chan WH, Luk IS, Luk WK, Lam SH, Ho YW. Diagnostic challenges of tuberculosis peritonitis in patients with and without end-stage renal failure. Clin Infect Dis. 2007 Dec 15;45(12):e141-6. doi: 10.1086/523727. PMID: 18190308.
  9. ↑ 9.0 9.1 9.2 9.3 "UpToDate". www.uptodate.com. Archived from the original on 10 March 2021. Retrieved 2 January 2021. Archived 10 March 2021 at the Wayback Machine
  10. ↑ "Review on Surgical Management of tuberculous small bowel stricutres" (PDF). Retrieved 2025-09-12.
  11. ↑ Sheer, Todd A.; Coyle, Walter J. (August 2003). "Gastrointestinal tuberculosis". Current Gastroenterology Reports. 5 (4): 273–278. doi:10.1007/s11894-003-0063-1. PMID 12864956. S2CID 22336101.
  12. ↑ "HIV and Tuberculosis". www.who.int. Retrieved 11 September 2025.
  13. ↑ Meintjes, Graeme; Maartens, Gary (25 July 2024). "HIV-Associated Tuberculosis". New England Journal of Medicine. 391 (4): 343–355. doi:10.1056/NEJMra2308181. PMID 39047241.
  14. ↑ Jose, Flores-Almanza; Daniela Naomi, Ortiz-Fernandez; Arturo Amed, Lopez-Marquez; Carolina, Juarez-Hernandez; Victor Salvador, Cabrera-Gallegos; Andres, Armendariz-Rodriguez; Hernandez Alberto, Robles Mendez (2022). "Acute Abdomen in a Patient with HIV, a Challenge for the Surgeon. Systematic Review and Case Report of Intra-Abdominal Tuberculosis". ARC Journal of Surgery. 8 (1): 1–6. doi:10.20431/2455-572X.0801001.
  15. ↑ 15.0 15.1 Kumar, Antriksh; Mandavdhare, Harshal S. (2022). "Abdominal Tuberculosis: A Brief History". Tuberculosis of the Gastrointestinal system. Springer Nature. pp. 3–8. doi:10.1007/978-981-16-9053-2_1. ISBN 978-981-16-9053-2.
  16. ↑ Maulahela, Hasan; Simadibrata, Marcellus; Nelwan, Erni Juwita; Rahadiani, Nur; Renesteen, Editha; Suwarti, S. W. T.; Anggraini, Yunita Windi (1 March 2022). "Recent advances in the diagnosis of intestinal tuberculosis". BMC gastroenterology. 22 (1): 89. doi:10.1186/s12876-022-02171-7. ISSN 1471-230X.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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