UNUSUAL PRESENTATIONS OF ABDOMINAL TUBERCULOSIS

Objective: To review unusual presenting features and diagnostic diffic ulties of abdominal tuberculosis in an endemic region. Design: Retrosp ective clinical study from 1984 to 1989, illustrated by case reports. Setting. A single hospital in Kuwait. Patients: Fifty patients with ab dominal tuberculosis established by the standard histologic and bacter iologic demonstration of acid-fast bacilli or tuberculous granulomas. Main Outcome Measures: Site of disease and unusual features at present ation. Results: Tubercular lesions are most commonly seen in the ileoc ecal region. They are also common in the ileum but are less common in the appendix and jejunum. Involvement of the ascending colon, rectum a nd upper gastrointestinal tract is rare. Abdominal tuberculosis presen ts in many ways depending on the degrees of ulceration, fibrous healin g, infection and caseating abscess formation. Conclusions: Abdominal t uberculosis should be considered in immigrants from regions where this disease is endemic who present with abdominal signs and symptoms. Ima ging studies, endoscopy and laparoscopy may preclude laparotomy for th e diagnosis of abdominal tuberculosis. Antituberculosis chemotherapy i s the mainstay of treatment.