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Abdominal Tuberculosis


Presentation

  • Oedematous jejunal loop was present with no intussusception and multiple mesenteric and paraaortic lymph node were present, representive mesenteric lymph node was biopsied.[omicsonline.org]
  • The study subjects attended the outpatient department with acute or chronic presentations.[intechopen.com]
  • Perforation was present in 10 patients, of which six had multiple perforations. Cocoon abdomen was present in four patients, two of whom had associated small-bowel stricture.[liebertpub.com]
  • Discussion Abdominal tuberculosis has a myriad of presentations [ 4 ]. Presentation varies from asymptomatic state to surgical emergency. Abdominal TB is seen more commonly between 25 and 45 years of age. Constuitional symptoms can be presentation.[oapublishinglondon.com]
  • Presenting features Abdominal pain was the predominant presenting feature. Fourteen patients reported a history of generalised abdominal pain.[nzma.org.nz]
Soft Tissue Mass
  • Computerised tomography scan revealed an in homogenous soft tissue mass lesion that is target or sausage shaped with enlarged mesenteric lymph nodes and proximal oedematous jejunum suggestive of jejunojejunal intussusception in the left lumbar region[omicsonline.org]
Rigor
  • The rigorous review process does not allow any compromise in quality It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost The frequency of publication supports many aspiring authors from India[jcdr.net]
Mediastinal Lymphadenopathy
  • These abnormalities included infiltrates ( n 7), pleural effusion ( n 7) and mediastinal lymphadenopathy ( n 5) and classical miliary disease ( n 1). In two patients, there were changes of previous TB disease.[academic.oup.com]
Pelvic Mass
  • Two patients with pelvic masses were suspected of having ovarian carcinoma until biopsy and were successfully treated with anti-TB chemotherapy.[academic.oup.com]
Epigastric Tenderness
  • On general physical examination, no abnormality was detected and the abdominal examination revealed epigastric tenderness. There were no hepatosplenomegaly or any mass felt.[omicsonline.org]
Lower Abdominal Pain
  • Rare clinical presentations include dysphagia, odynophagia and a mid oesophageal ulcer due to oesophageal tuberculosis, dyspepsia and gastric outlet obstruction due to gastroduodenal tuberculosis, lower abdominal pain and haematochezia due to colonic[ncbi.nlm.nih.gov]
Abdominal Bloating
  • Other symptoms include abdominal bloating, weight loss, 3 days of cough with yellow sputum, subjective fevers and night sweats.[afmr.org]
Persistent Vomiting
  • Case History A 16 year old male from an average socioeconomic status presented with dull aching abdominal pain of one month duration and persistent vomiting for one week. He had no history of cough, fever, loss of weight or bowel disturbances.[omicsonline.org]
Arthritis
  • Immunosuppressive therapy consisted in Prednisone or anti-TNF antibodies for the management of rheumatoid arthritis.[medwave.cl]
Neck Mass
  • mass 1 (1) Fistula-in-ano 1 (1) Investigations and diagnosis Blood investigations Blood tests revealed a microcytosis in 64%, anaemia in 64% and thrombocytosis in 46%.[academic.oup.com]
Neglect
  • Lower gastrointestinal tract tuberculosis: an important but neglected disease. Int J Colorectal Dis. 2009 Oct;24(10):1175-80. CrossRef PubMed Shah S, Thomas V, Mathan M, Chacko A, Chandy G, Ramakrishna BS, Rolston DD.[medwave.cl]

Workup

  • Diagnostic workup confirming the diagnosis of abdominal TB is outlined in [Table 4].[najms.org]
  • Results Of the total study subjects, 266 patients were chosen for diagnostic laparoscopy based on the fact that their findings and symptomatology were so vague that a conclusion could not be drawn from the clinical examination and the usual laboratory workup[intechopen.com]
Hyponatremia
  • Two weeks prior, she had presented with recurrent falls, functional decline, and hyponatremia.[ijmyco.org]
Thrombocytosis
  • […] mass 1 (1) Shortness of breath 1 (1) Post-cholecystectomy 1 (1) PR bleed mass at anal margin 1 (1) Neck mass 1 (1) Fistula-in-ano 1 (1) Investigations and diagnosis Blood investigations Blood tests revealed a microcytosis in 64%, anaemia in 64% and thrombocytosis[academic.oup.com]
Microcytosis
  • Fistula-in-ano 1 (1) Dysphagia 2 (2) Perianal mass 1 (1) Shortness of breath 1 (1) Post-cholecystectomy 1 (1) PR bleed mass at anal margin 1 (1) Neck mass 1 (1) Fistula-in-ano 1 (1) Investigations and diagnosis Blood investigations Blood tests revealed a microcytosis[academic.oup.com]
Liver Biopsy
  • One patient with abnormal liver enzymes had hepatic TB confirmed on liver biopsy. Another presented as an emergency with cholecystitis and underwent cholecystectomy. The pathology specimen showed TB.[academic.oup.com]

Treatment

  • Treatment failure: failure to improve with antituberculous treatment, or deterioration following initial improvement while on antituberculous treatment.[cochranelibrary.com]
  • […] of the disease after the end of treatment.[cochrane.org]
  • Most of the guidelines on the treatment of tuberculosis suggest that 6 months treatment is sufficient for extrapulmonary tuberculosis except for bone tuberculosis and tubercular meningitis.[clinicaltrials.gov]
  • The treatment(oral ATT) was stopped after a year. However the pain, and the original symptoms reappeared after 2 months. This time the treatment was the same, also the streptomycin injection was given for 60 days.[doctor.ndtv.com]
  • Average treatment in this group was significantly longer than for ATB involving other sites (10 vs 7.3 months, p 0.04). Conclusions Laparoscopic biopsy should be performed if possible. Treatment times often exceed 6 months.[erj.ersjournals.com]

Prognosis

  • Large bowel tuberculosis and possible influencing factors for surgical prognosis: 30 years’ experience. World J Surg. 1997;21:500-4. Bernhard JS, Bhatia G, Knauer CM. Gastrointestinal Tuberculosis J Clin Gastrenterol. 2001;1:397-402.[ijsurgery.com]
  • It lends itself to a wide ranging differential that can include infection, inflammatory bowel disease and malignancy. 3 Prompt and accurate diagnosis leads to earlier tuberculosis treatment, which creates advantages not only with regard to patient prognosis[nzma.org.nz]
  • In our study population, most patients with abdominal TB showed a good response to anti-TB agents and had a good prognosis.[bmcinfectdis.biomedcentral.com]
  • […] peritoneal tuberculosis remains as a challenge due to the wide range of clinical presentations, nonspecific laboratory findings and superimposition of imaging findings with other diseases, particularly with peritoneal carcinomatosis, whose treatment and prognosis[scielo.br]

Etiology

  • Etiologic diagnosis required histopathological and bacteriological analysis. Endoscopy and laparoscopy play a key role in taking samples for biopsy [4], [7], [13], [14], [15].[medwave.cl]
  • […] strongyloidiasis are often considered the top priorities in the differential diagnosis. [15] Crohn's disease is uncommon in certain developing countries [16] and, therefore, in patients from those countries with the clinical picture of IBD, a tuberculous etiology[najms.org]

Epidemiology

  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and[ingentaconnect.com]
  • Abdominal tuberculosis: epidemiologic profile and management experience of 233 cases. J Pak Med Assoc. 2012;62(7):704-7. Palmer KR, Patil DH, Basran GS, Riordan JF, Silk DB. Abdominal tuberculosis in urban Britain-a common disease.[ijsurgery.com]
  • Recent epidemiological work is reviewed, and its relationship to these changes considered. The distribution of disease along the gastrointestinal tract and in the mesentery is discussed.[karger.com]
  • Epidemiological study of abdominal tuberculosis among Indian migrants and the indigenous population of Leicester, 1972-1989. Gut 1992; 33:1085-8. 7. Bernardo J. Epidemiology and pathology of extrapulmonary and miliary tuberculosis, 2014.[najms.org]
  • Epidemiological study of abdominal tuberculosis among Indian migrants and the indigenous population of Leicester, 1972-1989. Gut. 1992 Aug;33(8):1085-8. Findlay JM, Addison NV, Stevenson DK, Mirza ZA.[ijmedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • PATHOPHYSIOLOGY OF ABDOMINAL TB There are several ways by which tuberculosis can involve abdomen (Table 1 )[ 10, 11 ]. Firstly, the tubercle bacilli may enter the intestinal tract through the ingestion of infected milk or sputum.[ncbi.nlm.nih.gov]
  • In: Gastrointestinal and liver disease: pathophysiology/ diagnosis/ management. Feldman M, Friedman LS, Sleisenger MH (Eds), Vol 2, 7th Edition, Saunders Publishers, China, 2002, pp. 1864-1913. 6. Bolukbas C, Bolukbas FF, Kendir T, etal.[ispub.com]

Prevention

  • Further studies are needed to increase our confidence as to whether six-month regimens are as good as nine-month regimens for preventing relapse ; and to provide information about treating abdominal TB in children and in people with HIV.[cochrane.org]
  • Given the correlation of peritoneal tuberculosis and elevated CA-125 levels, prompt diagnosis may prevent unnecessary laparotomies. Back to 2018 Program[afmr.org]
  • Park K, Park’s textbook of Preventive & Social Medicine. 19th ed India M/S Banarasidas Bhanot. 2007: 768. Kapoor VK, Abdominal tuberculosis. The Indian contribution. Indian J Gastroenterol. 1998;17:141-7.[msjonline.org]
  • Adhesions between the bowel loops prevent free perforation but promote formation of intestinal fistulae. Unlike the ulcerative form, hypertrophic intestinal tuberculosis commonly occurs in relatively well-nourished patients.[patientcareonline.com]
  • Centers for Disease Control and Prevention (CDC). Implementation of new TB screening requirements for U. S. -bound immigrants and refugees - 2007-2014. MMWR Morb Mortal Wkly Rep 2014;63:234-6.[najms.org]

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