Methods: An observational study was undertaken during a 11-year period (2006-2017), which included children under 18 years of age with abdominal tuberculosis under two of the following criteria: + tuberculin skin test, + BAAR, + Xpert, + Micobacterium tuberculosis or bovis culture.
Fifteen children were diagnosed with abdominal tuberculosis. Of the 15 patients included in the study, 10 were male and 5 were female. The median age at presentation was 7 years (range 4 months- 15 years). The median duration of symptoms prior to diagnosis was 2 months (range 1-24 months).
The tuberculin skin test was positive >10 mm in 4 patients (26.6%), 9 (60%) presented with an acute abdomen, diarrhea in 8 (53.3%), constipation in 3 (20%), rectal bleeding in 2 (13.3%), palpable abdominal mass in 5 (33%), hepatomegaly in 3 (20%) splenomegaly in 3 (20%), ascites in 5 (33.3%) and four (26.6%) had family history of TB. BAAR test was positive in 6 (40%) A positive culture was obtained in 7 patients (46%) four were M. bovis and the rest M. tuberculosis. Only in three patients underwent Xpert TB test which resulting positive .
Eight patients (53%) had enlarged intra-abdominal lymph nodes, abdominal mass in 6 (40%); ascites in 5 (33.3%) and calcifications in 4 (26.6%). Chest X-ray was abnormal in three patients.
Five patients (33.3%) were admitted with the diagnosis of lymphoma and one with Crohn´s disease. Twelve children underwent laparotomy. Eight developed bowel perforation and all required intestinal resection. Three were multidrug- resistant. Five patients had immunodeficiency. Duration of treatment was 18 to 24 months. None of the children died.
Conclusion: The diagnosis of abdominal tuberculosis may be especially challenging as lack of suspicion often leads to delayed diagnosis and if not treated early can lead to very severe complications, so the clinician should have a high level of suspicion for early diagnosis and appropriate treatment.
N. Gonzalez S,
M. Macias, None