Tuberculosis is a global health problem causing significant morbidity and mortality.
According to the Global tuberculosis report by WHO in 2017,
the annual incidence of tuberculosis was 10.4 million and about 1.7 million people died from the disease in 2016. Tuberculosis also became one of the top ten causes of morbidity worldwide. About 64% of the cases were reported from the seven countries,
with India leading the count,
followed by Indonesia,
and South Africa. In the last few decades we have seen a rise in the trend of the disease due the pandemic of AIDS and the use of immunosuppressive drugs.
Extrapulmonary tuberculosis accounts for 10–12% of the total tuberculosis cases with abdominal involvement seen in about 11-16% of the extrapulmonary cases.
Abdominal tuberculosis can be caused by mycobacterium tuberculosis in an immunocompetent host or mycobacterium avium in immunocompromised host.
Mycobacterium reaches the gastrointestinal tract via hematogenous spread,
ingestion of infected sputum or direct spread from infected contiguous lymph nodes.[4,5,6]
Abdominal tuberculosis can possibly involve every organ system such as the peritoneum,
visceral and the genitourinary systems with varying degrees of concurrence.[3,5,6,7]
It is predominantly a disease of the young with 2/3rds of the patients being between 21-40 years,
with slight female preponderance. In children,
peritoneal and lymphatic involvement is more common than gastrointestinal involvement,
which is seen in adults.
Clinically patients present with nonspecific symptoms of abdominal pain,
fever and weight loss.
Computed tomography (CT) is the imaging modality of choice in the detection and assessment of abdominal tuberculosis. However the CT features can mimic various inflammatory and neoplastic disorders such as lymphoma,
amoebiasis and adenocarcinoma.[2,6,7]
The diagnosis of abdominal tuberculosis thus poses a challenge owning to the nonspecific clinical presentation and varied imaging findings.
This delay in the diagnosis increases the risk of potentially devastating complications which may bring the patient to the emergency room with an acute abdomen. Acute manifestations of abdominal tuberculosis can be either intestinal obstruction (47.1%) secondary to stricture and adhesions,
followed by perforative peritonitis (31.4%),
acute appendicitis (10%) and others including cocoon(11.5%).[8,9]