Indian tubercular belly: A prospective study of 140 patients of abdominal tuberculosis and their outcomes

Abstract

Background: Abdominal tuberculosis is an important yet ignored entity in the spectrum of tuberculosis which has been dominated by pulmonary tuberculosis. Diagnosis and treatment are often delayed due to nonspecific symptoms. In this study, we aimed to highlight the clinical features, diagnostic methods and outcomes of abdominal tuberculosis.

Methods: A prospective study was conducted in tertiary referral centre where all patients referred to drug distribution centres (DOTS centre) for abdominal tuberculosis were identified. Their demographic clinical and radiological profile was evaluated. These patients were followed-up for their treatment course for complications and outcomes.

Results: A total of 140 patients who were labelled abdominal tuberculosis over a period of 2 years were reviewed at tuberculosis drug distribution centre (DOTS). Mean age of study population was 35.42 ± 12.53 years and majority of the population were males, 58.6% (82). The most common presenting symptom was abdominal pain which was seen in 82.8% (n = 116) of the patients, followed by feverin 65.6% (n = 92); 22.8% (n = 32) were seropositive for HIV and 44.2% (n = 62) had luminal tuberculosis of which ileocecal was the most common site. Peritoneum was second most common site which was involved in 26.4% (n = 37) of the patients followed by mixed tuberculosis involving more than one type. Confirmed diagnosis was achieved in 74 patients (52.8%), while the remaining 66 patients (47.14%) were diagnosed clinically. During follow-up, 12 patients were lost to follow-up; 113 (80.7%) had complete response, while 3 (2.14%) patients died during treatment.

Conclusion: Abdominal tuberculosis usually presents with nonspecific complaints which require high index of suspicion. Most patients require only medical therapy which has good results.

Keywords: Abdominal Koch; HIV; abdominal pain; extra pulmonary tuberculosis.

Figure 1

(a) Abdominal X-ray shows multiple air fluid levels suggestive small bowel obstruction, (b) USG abdomen showing necrotic conglomerated retroperitoneal lymphnodes, (c) CT abdomen showing ileocecal thickening, (d) CT abdomen showing nodes along with vascular encasement, (e) Colonoscopic image showing ulceronodular mucosa of ileocecal junction and (f) Ulceronodular mucosa of colon

Figure 2

(a) Laparoscopic image showing studded mesentery and omentum, (b) image showing perforation of jejunum and (c) laparoscopic repair of jejunal perforation