Abdominal tuberculosis can manifest in almost every abdominopelvic organ:
- gastrointestinal tuberculosis
- tuberculous peritonitis
- tubercular lymphadenopathy
- visceral tuberculosis
- hepatic tuberculosis
- gallbladder tuberculosis
- pancreatic tuberculosis
- splenic tuberculosis
- genitourinary tuberculosis
- renal tuberculosis
- bladder and ureteric tuberculosis
- prostatic tuberculosis
- scrotal tuberculosis (testes, epididymis, seminal vesicles, ductus deferens)
- tuberculous pelvic inflammatory disease (female)
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Clinical presentation
The most common clinical features are 3:
- fever (75%)
- abdominal pain (65%)
- weight loss (36%)
Pathology
There are three main pathways for tuberculous infection of the abdomen 1,2:
- ingestion of infected milk or sputum initially affects gastrointestinal tract mucosa, followed by the remainder of the bowel wall, regional lymph nodes and peritoneum
- hematogenous spread to the peritoneum, lymph nodes and solid viscera
- direct spread to the peritoneum, e.g. from skeletal tuberculosis via a psoas abscess
Radiographic features
Ultrasound
Abdominal ultrasound has 63% sensitivity and 68% specificity in diagnosing abdominal tuberculosis when the patient is confirmed to have tuberculosis infection. Therefore, negative abdominal ultrasound findings cannot rule out abdominal tuberculosis. Ultrasound findings for abdominal tuberculosis are not specific. These are 4:
- ascites
- mutliple abdominal lymph nodes
- hepatic lesions
- splenic lesions
CT
CT features of abdominal tuberculosis are not specific, including 3:
- enlarged lymph nodes (commonly at mesenteric, celiac, porta hepatis, and peripancreatic regions)
- peritoneal involvement (ascites, smooth peritoneal thickening with enhancment after intravenous contrast administration)
- intestinal involvement (bowel wall thickening, enlarged lymph nodes compressing on the bowel, commonly affecting terminal ileum and cecum in 90% of the cases)
- liver parenchymal involvement is rare (in either miliary or macronodular patterns)
- splenic and pancreatic involvements are rare
- involvement of suprarenal glands and genitourinary system
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