ABDOMINAL TUBERCULOSIS IN CHILDREN - REVIEW OF 26 CASES

The protean clinical manifestations and varied complications of abdomi nal tuberculosis continue to challenge the diagnostic acumen and thera peutic skills of all physicians. Although abdominal tuberculosis in ch ildren has not been common in the United States over the past 2 decade s, the authors found 26 case reports for the period 1980-1993. Three c linical patterns were evident: intestinal (13) peritoneal (9), and asy mptomatic with incidental calcifications apparent on abdominal radiogr aphs (4). The diagnosis was suspected for only 23% of these cases, whi ch emphasizes the nonspecific symptomatology caused by this extrapulmo nary manifestation and the need for a high index of suspicion to make a prompt diagnosis. In this study, 24 of the 26 (91%) were of Hispanic origin; the other two were Indo-Chinese, another high-risk group. Mos t patients (88%) had a positive PPD skin test result. Mycobacteria wer e isolated from 15 of 21 (71.4%) cultures, with M bovis in 80% and M t uberculosis in 20%. Antituberculous chemotherapy is the mainstay of tr eatment; surgery is reserved for tissue diagnosis in cases of peritone al tuberculosis and for the management of complications of intestinal tuberculosis. The response to chemotherapy usually is excellent, and l ong-term sequelae are uncommon. It appears that steroids do not decrea se the incidence or degree of fibrosis in intestinal tuberculosis. Cop yright (C) 1996 by W.B. Saunders Company.