The remaining 5 patients were diagnosed by ascitic fluid diagnostic features (exudative fluid, predominance of lymphocytes, and no tumour cells), positive tuberculous skin test and/or tuberculous exposure, and radiological imaging, suggestive of TB and a positive response to antituberculous treatment.
Antituberculous treatment was given to all of the patients. It consisted of isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months and isoniazid and rifampicin for a period of 9 to 12 months without any complications. No patient showed a relapse of disease during the follow-up period (6–15 months).
TB is regarded as a disease with insidious onset and chronic presentation, most patients having symptoms for a few weeks to months, sometimes years; Lambrianides et al (15) even stated that TB is rarely an emergency. However, in our study, 1 patient presented with acute abdomen. Abdominal masses mimicking Burkitt lymphoma were reported in a paediatric group; this presentation makes the diagnosis of TB more difficult. In our series, 2 patients presented with abdominal mass mimicking lymphoma and the defined diagnosis was obtained by histopathological studies. Because of the nonspecific symptoms and physical findings, diagnosis is often delayed. Delay may range from 1 month to 6 years (16–18); mean delay in the present study was 3 months (range 4 days–1 year).
1. Dye C, Scheele S, Dolin P, et al
. Consensus statement. Global burden of tuberculosis
: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999; 282:677–686.
2. Direction de Soins de Santé de Base, Ministère de la Santé publique, République Tunisienne. Guide Pratique Programme Lutte Antituberculeuse. Tunis: SAGEP; 1999.
3. Lazarus AA, Thilagar B. Abdominal tuberculosis
. Dis Mon 2007; 53:32–38.
4. Demir K, Okten A, Kaymakoglu S, et al
. Tuberculous peritonitis – reports of 26 cases, detailing diagnostic and therapeutic problems. Eur J Gastroenterol Hepatol 2001; 13:581–585.
5. Sochocky S. Tuberculous peritonitis. A review of 100 cases. Am Rev Respir Dis 1967; 95:398–401.
6. Snider DE, Reider HL, Combs D, et al
. Pediatr Infect Dis J 1988; 7:271–278.
7. Lee S, Bloch A, Onorato I. Changes in reported tuberculosis
cases in children
less than 15 years old, U.S., 1988–1991. Paper presented at the 33rd Interscience Conference on Microbiological Agents and Chemotherapy. October 1993; New Orleans.
8. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis –presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005; 22:685–700.
9. Lin YS, Huang YC, Chang LY, et al
. Clinical characteristics of tuberculosis
in the north of Taiwan. J Microbiol Immunol Infect 2005; 38:41–46.
10. Erkan T, Cam H, Ozkan HC, et al
. Clinical spectrum of acute abdominal
pain in Turkish pediatric patients: a prospective study. Pediatr Int 2004; 46:325–329.
11. Cruz AT, Starke JR. Clinical manifestations of tuberculosis
. Paediatr Respir Rev 2007; 8:107–117.
12. Tanrikulu AC, Aldemir M, Gurkan F, et al
. Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey. J Gastroenterol Hepatol 2005; 20:906–909.
13. Gurkan F, Ozates M, Bosnak M, et al
. Tuberculous peritonitis in 11 children
: clinical features and diagnostic approach. Pediatr Int 1999; 41:510–513.
14. Maltezou HC, Spyridis P, Kafetzis DA. Extra-pulmonary tuberculosis
. Arch Dis Child 2000; 83:342–346.
15. Lambrianides AL, Ackroyd N, Shorey BA. Abdominal tuberculosis
. Br J Surg 1980; 67:887–889.
16. Collado C, Stirnemann J, Ganne N, et al
. Gastrointestinal tuberculosis
: 17 cases collected in 4 hospitals in the northeastern suburb of Paris. Gastroenterol Clin Biol 2005; 29:419–424.
17. Das P, Shukla HS. Clinical diagnosis of abdominal tuberculosis
. Br J Surg 1976; 63:941–946.
18. Bernhard JS, Bhatia G, Knauer CM. Gastrointestinal tuberculosis
: an eighteen-patient experience and review. J Clin Gastroenterol 2000; 30:397–402.
19. Yilmaz T, Sever A, Gür S, et al
. CT findings of abdominal tuberculosis
in 12 patients. Comput Med Imaging Graph 2002; 26:321–325.
20. Dandapat MC, Mohan Rao V. Management of abdominal tuberculosis
. Indian J Tubercul 1985; 32:126–129.
21. Kapoor VK, Chattopadhyay TK, Sharma LK. Radiology of abdominal tuberculosis
. Australas Radiol 1988; 32:365–367.
22. Rasheed S, Zinicola R, Watson D, et al
and gastrointestinal tuberculosis
. Colorectal Dis 2007; 9:773–783.
23. Riquelme A, Calvo M, Salech F, et al
. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 2006; 40:705–710.
24. Hillebrand DJ, Runyon BA, Yasmineh WG, et al
. Ascitic fluid adenosine deaminase insensitivity in detecting tuberculous peritonitis in the United States. Hepatology 1996; 24:1408–1412.
25. Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma: abdominal tuberculosis
. World J Gastroenterol 2003; 9:1098–1101.
26. al-Quorain AA, Facharzt, Satti MB, et al. Abdominal tuberculosis
in Saudi Arabia: a clinicopathological study of 65 cases. Am J Gastroenterol
27. Pfaller MA. Application of new technology to the detection, identification, and antimicrobial susceptibility testing of mycobacteria. Am J Clin Pathol 1994; 101:329–337.
28. Rai S, Thomas WM. Diagnosis of abdominal tuberculosis
: the importance of laparoscopy. J R Soc Med 2003; 96:586–588.