Skip to main content

Advertisement

SpringerLink
Log in

The Spectrum of Abdominal Tuberculosis in a Developed Country: A Single Institution’s Experience Over 7 Years

  • original article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The incidence of human immunodeficiency virus (HIV) infection is rising, and as a result, tuberculosis (TB) has become a resurgent problem in many developed countries.

Objectives

The aim of this study was to review the spectrum of abdominal TB and its surgical management in our institution.

Methods

A retrospective review of all abdominal TB cases notified to the health authorities by our institution from Jan 01 to Oct 07 was performed.

Results

There were 57 patients (37 men) with abdominal TB, with a median age of 47 (range 14–74) years. Active pulmonary TB was present in 27 patients (47%). Positive HIV status was present in 30% and untested in 58%. The majority of patients underwent computed tomography scans (n = 50, 88%). The main radiological findings included bowel thickening, lymphadenopathy, ascites, free gas suggestive of perforation, and abscesses. The diagnosis of TB was confirmed on microbiological and/or histological examination in 72%, while the remaining 28% were diagnosed based on the clinical presentation and radiological imaging. All patients were commenced on anti-tuberculous therapy. TB involved the small or large bowel in 33 patients, mesenteric lymphadenopathy in 24, peritoneum in 13, spleen in seven, pancreas in two, anus in two, and the liver in two. Disseminated (including pulmonary) TB occurred in 27 patients (47%), while isolated intra-abdominal TB occurred in the remaining 30 patients (53%). Twenty-five patients (44%) underwent surgery—16 laparotomies (six perforated viscus, five intestinal obstruction, three suspected malignancies, and two for suspected acute abdomen), five laparoscopic procedures (four diagnostic, one gastrojejunostomy bypass for gastric outlet obstruction), two appendicectomies, one drainage of abscess, and one anal fistulotomy.

Conclusions

Although TB is eminently treatable medically, surgery is still often required for suspected or confirmed abdominal TB presenting with acute complications or as atypical diagnostic problems. The role of laparoscopy is likely to be more significant in future in the management of abdominal TB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. WHO. Tuberculosis Facts. 2007. http://www.who.int/tb/publications/2007/factsheet_2007.pdf

  2. Wagner KR, Bishai WR. Issues in the treatment of Mycobacterium tuberculosis in patients with human immunodeficiency virus infection. AIDS 2001;15:S203–S212. doi:10.1097/00002030-200100005-00024.

    Article  PubMed  CAS  Google Scholar 

  3. Aston NO. Abdominal tuberculosis. World J Surg 1997;21(5):492–499. doi:10.1007/PL00012275.

    Article  PubMed  CAS  Google Scholar 

  4. Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma: abdominal tuberculosis. World J Gastroenterol 2003;9(5):1098–1101.

    PubMed  Google Scholar 

  5. Rosengart TK, Coppa GF. Abdominal mycobacterial infections in immunocompromised patients. Am J Surg 1990;159:125–130. doi:10.1016/S0002-9610(05)80617-8.

    Article  PubMed  CAS  Google Scholar 

  6. Jadvar H, Mindelzun RE, Olcott EW, Levitt DB. Still the great mimicker: abdominal tuberculosis. Am J Roentgenol 1997;168:1455–1460.

    CAS  Google Scholar 

  7. Pereira JM, Madureira AJ, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol 2005;55(2):173–180. doi:10.1016/j.ejrad.2005.04.015.

    Article  PubMed  Google Scholar 

  8. Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol 2004;10(24):3647–3649.

    PubMed  Google Scholar 

  9. Kapoor VK. Abdominal tuberculosis. Postgrad Med J 1998;74(874):459–467.

    PubMed  CAS  Google Scholar 

  10. Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995;33:691–705.

    PubMed  CAS  Google Scholar 

  11. Suri S, Gupta S, Suri R. Computed tomography in abdominal tuberculosis. Br J Radiol 1999;72:92–98.

    PubMed  CAS  Google Scholar 

  12. Demirkazik FB, Akhan O, Ozmen MN, Akata D. US and CT findings in the diagnosis of tuberculous peritonitis. Acta Radiol 1996;37:517–520.

    Article  PubMed  CAS  Google Scholar 

  13. Balthazar EJ, Gordon R, Hulnick D. Ileocecal tuberculosis: CT and radiologic evaluation. Am J Roentgenol 1990;154:499–503.

    CAS  Google Scholar 

  14. van Cleeff MR, Chum HJ. The proportion of tuberculosis cases in Tanzania attributable to human immunodeficiency virus. Int J Epidemiol 1995;24(3):637–642. doi:10.1093/ije/24.3.637.

    Article  PubMed  Google Scholar 

  15. Range N, Ipuge YA, O’Brien RJ, Egwaga SM, Mfinanga SG, Chonde TM et al. Trend in HIV prevalence among tuberculosis patients in Tanzania, 1991–1998. Int J Tuberc Lung Dis 2001;5(5):405–412.

    PubMed  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention (CDC). Reported HIV status of tuberculosis patients—United States, 1993–2005. MMWR Morb Mortal Wkly Rep 2007;56(42):1103–1106.

    Google Scholar 

  17. Marshall BG, Mitchell DM, Shaw RJ, Marais F, Watkins RM, Coker RJ. HIV and tuberculosis co-infection in an inner London hospital—a prospective anonymized seroprevalence study. J Infect 1999;38(3):162–166. doi:10.1016/S0163-4453(99)90244-X.

    Article  PubMed  CAS  Google Scholar 

  18. UNAIDS. AIDS epidemic update. 2007. http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf.

  19. Lim MK. HIV testing. Health Policy Monitor, October 2007. http://www.hpm.org/survey/sg/a10/3.

  20. Moszynski P. Patients with tuberculosis in poor countries must be tested for HIV. BMJ 2007;334(7595):659. doi:10.1136/bmj.39167.337616.DB.

    Article  PubMed  Google Scholar 

  21. Muga R, Ferreros I, Langohr K, de Olalla PG, Del Romero J, Quintana M, Spanish Multicenter Study Group of Seroconverters (GEMES) et al. Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS 2007;21(18):2521–2527.

    Article  PubMed  Google Scholar 

  22. Elliott AM, Halwiindi B, Hayes RJ, Luo N, Mwinga AG, Tembo G et al. The impact of human immunodeficiency virus on response to treatment and recurrence rate in patients treated for tuberculosis: two-year follow-up of a cohort in Lusaka, Zambia. J Trop Med Hyg 1995;98(1):9–21.

    PubMed  CAS  Google Scholar 

  23. Chau TN, Leung VK, Wong S, Law ST, Chan WH, Luk IS et al. Diagnostic challenges of tuberculosis peritonitis in patients with and without end-stage renal failure. Clin Infect Dis 2007;45(12):141–146. doi:10.1086/523727.

    Article  Google Scholar 

  24. Malik GH, Al-Harbi AS, Al-Mohaya S, Al-Khawajah H, Kechrid M, Al Hassan AO et al. Eleven years of experience with dialysis associated tuberculosis. Clin Nephrol 2002;58(5):356–362.

    PubMed  CAS  Google Scholar 

  25. Haddad FS, Ghossain A, Sawaya E, Nelson AR. Abdominal tuberculosis. Dis Colon Rectum 1987;30:724–735. doi:10.1007/BF02561699.

    Article  PubMed  CAS  Google Scholar 

  26. McGee GS, Lester WF, Potts J et al. Gastrointestinal tuberculosis resurgence of an old pathogen. Am Surg 1989;55:16–19.

    PubMed  CAS  Google Scholar 

  27. Rasheed S, Zinicola R, Watson D, Bajwa A, McDonald PJ. Intra-abdominal and gastrointestinal tuberculosis. Colorectal Dis 2007;9(9):773–783. doi:10.1111/j.1463-1318.2007.01337.x.

    Article  PubMed  CAS  Google Scholar 

  28. King HC, Voss EC Jr. Tuberculosis of the cecum simulating carcinoma. Dis Colon Rectum 1980;23(1):49–53. doi:10.1007/BF02587201.

    Article  PubMed  CAS  Google Scholar 

  29. Gadwood KA, Bedetti CD, Herbert DL. Colonic tuberculosis mimicking annular carcinoma: report of a case. Dis Colon Rectum 1981;24(5):395–398. doi:10.1007/BF02603427.

    Article  PubMed  CAS  Google Scholar 

  30. Gopal SV, Panda S, Kadambari D, Srinivasan K. Carcinoma colon associated with tuberculosis: an unusual presentation. Int J Colorectal Dis 2007;22(7):843–844. doi:10.1007/s00384-005-0783-9.

    Article  PubMed  Google Scholar 

  31. Isaacs P, Zissis M. Colonic tuberculosis and adenocarcinoma: an unusual presentation. Eur J Gastroenterol Hepatol 1997;9(9):913–915.

    PubMed  CAS  Google Scholar 

  32. Kaushik R, Sharma R, Attri AK. Coexisting tuberculosis and carcinoma of the colon: a report of two cases and a review of the literature. Trop Gastroenterol 2003;24(3):137–139.

    PubMed  Google Scholar 

  33. Goudarzi HA, Mason LB. Fatal rectal bleeding due to tuberculosis of the cecum. JAMA 1982;247(5):667–668. doi:10.1001/jama.247.5.667.

    Article  PubMed  CAS  Google Scholar 

  34. Weissman D, Gumaste VV, Dave PB, Keh W. Bleeding from a tuberculous gastric ulcer. Am J Gastroenterol 1990;85(6):742–744.

    PubMed  CAS  Google Scholar 

  35. Sahoo D, Mahapatra MK, Salim S. Rectal tuberculosis: a rare case. Trop Gastroenterol 2004;25(2):84–85.

    PubMed  Google Scholar 

  36. Monkemuller KE, Lewis JB Jr. Massive rectal bleeding from colonic tuberculosis. Am J Gastroenterol 1996;91(7):1439–1441.

    PubMed  CAS  Google Scholar 

  37. Wu CS, Wang SH, Kuo TT. Pancreatic tuberculosis mimicking pancreatic head carcinoma: a case report and review of the literature. Infection 1994;22(4):287–289. doi:10.1007/BF01739920.

    Article  PubMed  CAS  Google Scholar 

  38. Claro I, Leitão CN, Oliveira P, Correia J, da Costa JD, Almeida JM et al. Tuberculous mesenteric lymphadenitis mimicking pancreatic carcinoma. Hepatogastroenterology 1996;43(12):1653–1655.

    PubMed  CAS  Google Scholar 

  39. Kim YS, Moon JS, Lee JW, Kim I, Ryu SH, Paik IW. Solitary intra-abdominal tuberculous lymphadenopathy mimicking duodenal GIST. Korean J Intern Med 2005;20(1):72–75.

    PubMed  Google Scholar 

  40. Brookes MJ, Field M, Dawkins DM, Gearty J, Wilson P. Massive primary hepatic tuberculoma mimicking hepatocellular carcinoma in an immunocompetent host. Med Gen Med 2006;8(3):11.

    Google Scholar 

  41. Pereira JM, Madureira AJ, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol 2005;55(2):173–180. doi:10.1016/j.ejrad.2005.04.015.

    Article  PubMed  Google Scholar 

  42. Vanhoenacker FM, De Backer AI, Op DB et al. Imaging of gastrointestinal and abdominal tuberculosis. Eur Radiol 2004;14:103–115.

    Google Scholar 

  43. Klimach OE, Ormerod LP. Gastrointestinal tuberculosis: a retrospective review of 109 cases in a district general hospital. Q J Med 1985;56:569–578.

    PubMed  CAS  Google Scholar 

  44. Sherman S, Rohwedder JJ, Ravikrishnan KP et al. Tuberculous enteritis and peritonitis: report of 36 general hospital cases. Arch Intern Med 1980;140:506–508. doi:10.1001/archinte.140.4.506.

    Article  PubMed  CAS  Google Scholar 

  45. Gilinsky NH, Marks IN, Kottler RE et al. Abdominal tuberculosis: a 10-year review. S Afr Med J 1983;64:849–857.

    PubMed  CAS  Google Scholar 

  46. Anand BS, Nanda R, Schdev GK. Response of tuberculous stricture to antituberculous treatment. Gut 1988;29:62–69. doi:10.1136/gut.29.1.62.

    Article  PubMed  CAS  Google Scholar 

  47. Clarke DL, Thomson SR, Bissetty T, Madiba TE, Buccimazza I, Anderson F. A single surgical unit’s experience with abdominal tuberculosis in the HIV/AIDS era. World J Surg 2007;31(5):1087–1096. doi:10.1007/s00268-007-0402-8.

    Article  PubMed  CAS  Google Scholar 

  48. Horvath KD, Whelan RL. Intestinal tuberculosis: return of an old disease. Am J Gastroenterol 1998;93(5):692–696. doi:10.1111/j.1572-0241.1998.207_a.x.

    Article  PubMed  CAS  Google Scholar 

  49. Wolfe JHN, Behn AR, Jackson BT. Tuberculous peritonitis and the role of diagnostic laparoscopy. Lancet 1979;1(8121):852–853. doi:10.1016/S0140-6736(79)91266-2.

    Article  PubMed  CAS  Google Scholar 

  50. Apaydin B, Paksoy M, Bilir M, Zengin K, Saribeyoglu K, Taskin M. Value of diagnostic laparoscopy in tuberculous peritonitis. Eur J Surg 1999;165(2):158–163. doi:10.1080/110241599750007360.

    Article  PubMed  CAS  Google Scholar 

  51. Al Quorain AA, Satti MB, al Gindan YM, al Ghassab GA, al Freihi HM. Tuberculous peritonitis: the value of laparoscopy. Hepatogastroenterology 1991;38:37–40.

    PubMed  Google Scholar 

  52. Jorgensen JO, Lalak NJ, Hunt DR. Is laparoscopy associated with a lower rate of postoperative adhesions than laparotomy? A comparative study in the rabbit. Aust N Z J Surg 1995;65:342–344. doi:10.1111/j.1445-2197.1995.tb00651.x.

    Article  PubMed  CAS  Google Scholar 

  53. Schippers E, Tittel A, Ottinger A, Schumpelick V. Laparoscopy versus laparotomy: comparison of adhesion formation after bowel resection in a canine model. Dig Surg 1998;15:145–147. doi:10.1159/000018608.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Ker-Kan Tan, Kenneth Chen & Richard Sim

Authors
  1. Ker-Kan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ker-Kan Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, KK., Chen, K. & Sim, R. The Spectrum of Abdominal Tuberculosis in a Developed Country: A Single Institution’s Experience Over 7 Years. J Gastrointest Surg 13, 142–147 (2009). https://doi.org/10.1007/s11605-008-0669-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0669-6

Keywords

Search

Navigation