Diagnostic dilemmas in abdominal tuberculosis in children
Date
2001
Authors
Saczek K.B.
Schaaf H.S.
Voss M.
Cotton M.F.
Moore S.W.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
The authors review 45 pediatric patients with intra-abdominal tuberculosis (ATB) treated between May 1990 and April 1998. The diagnosis was confirmed histologically or by positive culture for Mycobacterium tuberculosis. Clinical presentation was with an abdominal mass (12), subacute obstruction (11), ascites (5), mass and ascites (4), peritonitis (4), and 9 unusual presentations. Mantoux tests were positive in 68% of patients tested. There were radiologic features suggestive of pulmonary TB in 29 patients (64%); abnormal abdominal radiographs were recorded in 21 (47%). Lymphadenopathy was noted on abdominal ultrasound in 23 of 30 patients (77%) and on computed tomography scan in a further 3 of 8 patients investigated. Ascitic fluid adenosine deaminase (ADA) levels were greater than 30 IU/1 in 3 of 4 patients (75%), suggesting ATB. All 28 patients screened for human immunodeficiency virus were negative. A surgical procedure was performed in 39 patients, 29 (74%) had an elective diagnostic laparotomy for tissue diagnosis. One (3.4%) developed a postoperative intra-abdominal abscess. Ten (26%) presented with complications requiring surgical intervention including perforated viscus, segmental bowel resection, strictureplasty, adhesiolysis, or ileostomy. One of the latter died due to sepsis after having complications of persistent intestinal obstruction and cecal perforation. The authors recommend an aggressive approach to patients with suspected ATB in order to obtain an early definitive diagnosis, prevent complications, and reduce morbidity and mortality. They emphasize the importance of tissue diagnosis and confirmation by culture.
Description
Keywords
abdominal infection, abdominal mass, article, ascites, bacterium culture, clinical article, clinical feature, diagnostic approach route, early diagnosis, histopathology, human, infant, intestine perforation, Mycobacterium tuberculosis, peritonitis, priority journal, sepsis, surgical approach, tuberculin test, tuberculosis, Abdominal abscess, Algorithms, Biopsy, Child, Child, Preschool, Diagnosis, Differential, Female, Humans, Infant, Lymph nodes, Male, Peritoneum, Peritonitis, Tuberculous, Postoperative complications, Reoperation
Citation
Pediatric Surgery International
17
2-3
17
2-3