Sažetak
Abdominal tuberculosis (TB) alone or with disseminated TB is known to mimic other conditions with non-specific investigation findings. This study aims to evaluate the clinical presentations and
investigation findings of patients in our setting. The clinical records of 47 patients diagnosed as abdominal TB between January 1986 and December 2005 at the Wesley Guild Hospital Unit of the
Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, were reviewed. Fifty-five percent of the patients were women and mean age was 28 years. Common presenting symptoms and signs were abdominal pain 76.6%; ascites 59.6%; weight loss 53.2%; fever 29.8%. Average duration of symptoms before presentation was 3months. Thirteen percent of patients had earlier been treated for pulmonary tuberculosis in the hospital. ESR was elevated in 89%, ultrasound scans of abdomen were abnormal in 68%, showing ascites, hepatomegaly and or enlarged nodes. Mantoux test was positive in 33% and ascitic fluid was diagnostic for TB in 29%. Chest X-ray showed abnormal findings in 25% of the patients and sputum was positive for AFB in 14.3%. Three patients were HIV positive. Forty patients (85.1%) recovered after receiving anti-TB drugs for a period of 9-12 months. Seven patients, including the three with HIV infection died. Death of 2 patients was due to unrelated causes. We conclude that abdominal TB should be suspected in patients with chronic abdominal condition and ascites as no laboratory or radiological finding is gold standard in its diagnosis. However the condition carries good prognosis if promptly diagnosed and treated.
Keywords: Abdominal tuberculosis, management, outcome.
Résumé
La tuberculose abdominale seulement ou avec le TB répandu est connu comme imitant autres conditions avec des résultats d investigation non spécifiques. Cette étude avait pour but d évaluer les symptômes cliniques et les résultats des investigations des malades dans notre environnement. Les registres cliniques de 47 patients diagnostiqués ayant l e TB abdominale entre janvier 1986 a décembre 2005 dans l’unité de Wesley au centre Universitaire hospitalier d Obafemi Awolowo, Ile-Ife, Nigeria. Cinquante cinq pour cent des patients étaient des femmes avec une moyenne d age de 28 ans. Les symptômes présent et les signes étaient la douleur abdominale76.6%, ascites 59.6%, perte de poids 53.2%, fièvre 29.8%. La durée moyenne des symptômes avant la présentation était de 3 mois. Treize pour cent des patients avaient été traité d avance de la tuberculose pulmonaire a l’hôpital. LE ERS était élevé chez 89%, les scans de l abdomen étaient anormaux chez 68% ayant ascites, hépatomégalie et les noeuds élargis.Le test de Mantoux était positive chez 33 % et le fluide ascitique était diagnostiqué pour le TB chez 29%. Les rayons X de la poitrine démontrait les résultats anormaux chez 25% des patients et le crachat était positif pour l’AFB chez 14,3%. Trois patients étaient positifs au VIH. Quarante patients 85.1% guérissaient après avoir récu les médicaments anti tuberculeux pour une période de 9-12 mois. Sept patients inclus trois séropositif sontmort. La mort de deux patient était due a des causes non liées. Nous avons conclut que la TB abdominale doit être suspectée chez les patients avec des conditions abdominale chroniques. Cependant, le résultat du laboratoire ou radiologique reste le standard dans ce diagnostique et les conditions de bonne pronostique si précisement diagnostiqué et traité.
Correspondence: Dr. Adewale O. Adisa, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria. Email: wadisc@yahoo.com
Reference
Vyas K and Rathi P. Human immunodeficiency virus and abdominal tuberculosis—dual partners in a crime. J Assoc Physicians India. 1999;47: 309-312.
Sharma M.P and Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004:305-315.
Haddad F S, Ghossain A, Sawaya E and Nelson A.R. Abdominal tuberculosis. Dis. Colon Rectum 1987; 30: 724–735.
Rathi PM, Amarapurakar DN, Parikh SS, Joshi J, Koppikar GV and Amarapurkar AD. Impact of human immunodeficiency virus infection on abdominal tuberculosis in western India. J Clin Gastroenterol 1997;24 : 43-48.
Mehta JB, Dutt A, Harvill L and Mathews KM.Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era. Chest 1991 ; 99 : 1134
Khan R, Abid S, Jafri W, Abbas Z, Hameed K and Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians.World J Gastroenterol. 2006;12: 6371-6375.
Bayramicli O.U, Dabak G and Dabak R. A Clinical dilemma: abdominal tuberculosis. World J. Gastroeuterol. 2003: 9 (S) 1098–1101.
Ihekwaba FN. Abdominal tuberculosis: a study of 881 cases. J R Coll Surg Edinb. 1993; 38: 293-295.
Muneef M A, Memish Z, Mahmoud S A, Sadoon SA, Bannatyne R and Khan Y. Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum. Scand J Gastroenterol. 2001;36: 528-532
Singhal A, Gulati A, Frizell R and Manning AP. Abdominal tuberculosis in Bradford, UK: 1992-2002. Eur J Gastroenterol Hepatol. 2005; 17: 967-971.
Tanrikulu AC, Aldemir M, Gurkan F, Suner A, Dagli CA and Ece A. Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey Journal of Gastroenterology and Hepatology 20 (6), 906–909.
Kapoor VK. Abdominal tuberculosis. Postgrad Med J 1998; 74 : 459-466.
Vyravanathan S and Jeyarajah R. Postgrad Med J. 1980;56: 649-651.
Abdul-Ghaffar NU, Ramadan TT and Marafie A A Abdominal tuberculosis in Ahmadi, Kuwait: a clinico-pathological review. Trop Doct. 1998; 28: 137-139.
Leung V K, Law S T, Lam C W, Luk I S, Chau TN, Loke TK, Chan WH and Lam SH. Intestinal tuberculosis in a regional hospital in Hong Kong: a 10-year experience.Hong Kong Med J. 2006;12: 264-271.
Tuberculous Peritonitis – Report of 30 Cases and Review of the Literature. Bastani B, Shariatzadeh MR, Dehdashti F. Tuberculous Peritonitis – Report of 30 Cases and Review of the Literature. Q J Med 1985; 56: 549-557
Erhabor G. E, Adewole O, Adisa A. O and Olajolo O.A. Directly observed short course therapy for tuberculosis – a preliminary report of a three-year experience in a teaching hospital. J Nat’l Med Assoc. 2003; 95: 1082- 1088.
Khan R, Abid S, Jafri W, Abbas Z, Hameed K and Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol. 2006; 12(39):6371-6375.
Pereira JM, Madureira AJ, Vieira A and Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol. 2005; 55(2):173-180.
Kedar R.P, Shah P.P. Shivde R.S. and Malde H.M. Sonographic findings in gastrointestinal and peritoneal tuberculosis. AJR. 1994; 49:24-29.
Jain R., Sawhney S, Bhargava D.K. and Berry M. Diagnosis of abdominal tuberculosis: Sonographic findings in patients with early disease.AJR 1995; 165: 1391-1395.
Kolawole TM and Lewis EA. A radiologic study of tuberculosis of the abdomen (Gastro-intestinal tract). Am J Roentg 1975;123:348-358
Muneef M A, Memish Z, Mahmoud SA, Sadoon S A, Bannatyne R and Khan Y. Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum. Scand J Gastroenterol 2001 ; 36 : 528-532.
Durand F, Jebrak G, Pessayre D, Fournier M and Bernuau J. Hepatotoxicity of antitubercular treatments. Rationale for monitoring liver status. Drug Safety 1996: 394-405.
Singh J, Garg PK and Tandon RK. Hepatotoxicity due to antituberculous therapy. Clinical profile and reintroduction of therapy. J of Clin Gast 1996; 22: 211-214.
Findlay JM. Medical management of gastrointestinal tuberculosis. J R Soc Med 1982; 75:583-584.
Alrajhi AA, Halim MA, al Hokail A, Alrabiah F and al Omran K. Corticosteroid treatment of peritoneal tuberculosis.Clin Infect Dis.1988; 27: 52-56.
Guth AA and Kim U. The reappearance of abdominal tuberculosis. Surg Gynecol Obstet. 1991; 172(6):432-436.
Chong VH and Rajendran N. Tuberculosis peritonitis in Negara Brunei Darussalam. Ann Acad Med Singapore. 2005;34(9):548-552.
Gilinsky NH, Marks IN, Kottler RE and Price SK. Abdominal tuberculosis. A 10-year review. S Afr Med J. 1983;64(22):849-857.