Abdominal tuberculosis in children. Report of 10 cases.

Abdominal tuberculosis is a rare disease in children, characterized by its polymorphic clinicopathological features and diagnostic difficulties. The o bjective of this study was to assess the clinical, bacteriological, histolo gical and radiological characteristics of abdominal tuberculosis in childre n. Patients and methods: In a retrospective study conducted over a 7-year p eriod, the authors collected 10 cases (6 girls and 4 boys; mean age 11 year s) of abdominal tuberculosis in children. All patients satisfied the follow ing criteria : positive histological examination and or combination of radi ological signs suggestive of pulmonary tuberculosis, and or a favourable co urse in response to a trial of tuberculosis treatment. Results: The authors observed seven cases of mesenteric lymph node tuberculosis, five cases of peritoneal tuberculosis and two cases of intestinal tuberculosis. Extra-abd ominal tuberculosis was present in four of these patients. The main clinica l features were abdominal pain (4 cases) and abdominal distension (6 cases) . Abdominal ultrasonography visualized mesenteric lymphadenopathy (6 cases) , an abdominal mass (5 cases), free (1 case) and loculated ascites (1 case) . Barium enema and small bowell series showed stenosis of the small intesti ne (1 case), ileal ulcerations (1 case) and a retracted caecum (2 cases). E xploratory laparotomy, performed in 3 cases, showed whitish granulations an d peritoneal abscesses with caseous necrosis on histology. The differential diagnosis included Crohn's disease (1 case) and gastrointestinal cancer (1 case). Four-agent tuberculostatic treatement was prescribed in all patient s based on the combination of isoniazid, rifampicin, pyrazinamide, combined , at the start of treatment, with streptomycin (7 cases) and ethambutol (3 cases). The short-term outcome was favourable with no deaths. The long-term course was complicated by persistent ascites (1 case) and the development of portal hypertension (1 case). Conclusion : The prevention of this diseas e is based on compulsory BCG immunization, isolation and early treatment of all cases of active tuberculosis.