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Abdominal Tuberculosis in Children

Tinsa, Faten*; Essaddam, Leila*; Fitouri, Zohra; Brini, Ines*; Douira, Wiem; Becher, Saida Ben; Boussetta, Khadija*; Bousnina, Souad*

Journal of Pediatric Gastroenterology & Nutrition: June 2010 - Volume 50 - Issue 6 - p 634–638
doi: 10.1097/MPG.0b013e3181b6a57b
Original Articles: Gastroenterology

Background: Abdominal tuberculosis (TB) includes infection of the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. The most common forms of abdominal TB in children are adhesive peritonitis and nodal disease.

Patients and Methods: We report our experience with abdominal TB treated in our hospital from 1995 to 2008.

Results: Thirteen patients (3 boys and 10 girls) of mean age 9.8 years were diagnosed as having abdominal TB. Eight patients presented with abdominal distension and abdominal pain. Fever was seen in 4 patients. One patient had surgical abdominal pain and 2 had abdominal mass. Two patients had coexisting pleural effusion and 1 of them had multifocal TB. Abdominal TB involved peritoneum in 9, abdominal lymph nodes in 7, gastrointestinal tract in 3, spleen in 2 patients, and liver in 1. Ascitic fluid analysis of 9 patients showed exudative fluid with predominately lymphocytes. Laparotomy was performed in 3 patients. The diagnosis of abdominal TB was confirmed histopathologically in 5 patients and microbiologically in 3. The remaining patients had been diagnosed by ascitic fluid diagnostic features, abdominal imaging, tuberculin skin test, history of exposure, and a positive response to antituberculous treatment. Twelve patients completed the antituberculous therapy without any complications. One patient with multifocal TB had neurological sequelae.

Conclusions: In the areas with a high prevalence of tuberculosis and confirmatory investigations are inadequately available, treatment may be initiated, based on strong clinical diagnosis and supportive investigations. In such situations, it is the response to therapy that indirectly proves the diagnosis.

*Department of Pediatrics B, Tunisia

Department of Pediatric Emergency and Consultation, Tunisia

Department of Pediatric Radiology, Children's Hospital of Tunis, Tunis, Tunisia.

Received 8 March, 2009

Accepted 5 July, 2009

Address correspondence and reprint requests to Dr Faten Tinsa, Department of Pediatrics B, Children's Hospital of Tunis, Boulevard 9 avril, 1007 Jabbary, Bab Saadoun, Tunis, Tunisia (e-mail: faten.tinsa@hotmail.fr).

The authors report no conflicts of interest.

© 2010 Lippincott Williams & Wilkins, Inc.