ABDOMINAL TUBERCULOSIS - THE SURGICAL PERSPECTIVE

The increasing incidence of pulmonary tuberculosis (TB) has led many t o predict a corresponding increase in abdominal TB. This study reports the incidence, presentation, and outcome of abdominal TB to elucidate factors that might assist the surgeon to treat this potentially curab le disease. A retrospective review of patients diagnosed with tubercul osis between 1993 and 1995 was performed at two hospitals. Diagnosis o f abdominal TB was based on acid fast bacilli on tissue stains and/or culture. Seven patients were diagnosed with abdominal TB. Two patients were HIV positive; six were recent immigrants. Abdominal pain, fever, and significant weight loss were the most common symptoms. All preope rative radiologic tests failed to demonstrate findings suggestive of T B. All patients were brought to operation. Indications included perfor ated viscus (2), acute abdomen (1), small bowel obstruction (1), coloc utaneous fistula (1), pelvic neoplasm (1), and biliary colic (1). Abdo minal TB was either diagnosed or suspected intraoperatively in six pat ients. Postoperative anti-TB chemotherapy was promptly instituted. Alt hough abdominal TB can be cured medically if treated early enough, the nonspecific presentation delays diagnosis in the majority of cases. D iagnosis of abdominal TB can be made or at least highly suspected intr aoperatively such that anti-TB medications can be initiated promptly. Appropriate surgical therapy and prompt initiation of anti-tuberculosi s medications can successfully treat abdominal TB.