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Volume 43, Number 3, June 2010

Abdominal Tuberculosis in Children: A Diagnostic Challenge


Yo-Spring Lin, Yhu-Chering Huang, Tzou-Yien Lin


Received: February 25, 2009    Revised: May 25, 2009    Accepted: June 17, 2009   

 

Corresponding author:

Yhu-Chering Huang

 

Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s

Hospital, 5 Fu-Shin Street, Kweishan 333, Taoyuan, Taiwan.

E-mail: ychuang@adm.cgmh.org.tw

 



 

Background and purpose: 

Abdominal tuberculosis (TB) is a rare manifestation of childhood TB. Abdominal TB is characterized by long-lasting abdominal symptoms, which are usually confused with other conditions, and the diagnosis is usually delayed.



 

Methods:

During a 5-year period, we identified 10 cases of abdominal TB in a tertiary care children's hospital. Data including demographic characteristics, presenting symptoms, history of Bacille Calmette-Guérin vaccination, lesion sites, laboratory data, image findings, diagnosis, tuberculin skin test, risk factors, treatment, and outcome were collected and analyzed.



 

Results:

There were six female patients and four male patients, with a mean age of 14.7 years. One patient died due to the complication of disseminated TB with a pneumothorax. Household members with TB could be traced in six (60%) patients. The most common clinical presentations included fever (9/10), abdominal pain (8/10), and weight loss (8/9). The diagnosis of abdominal TB was suspected initially in only three patients; the others were not diagnosed until 7–36 days (mean=19 days) after hospitalization. The abnormal abdominal image findings, by either computed tomography or ultrasound, included lymphadenopathy (7/9), high-density ascites (6/9), thickening of the omentum or peritoneum (6/9), inflammatory mass (3/9), bowel wall thickening (1/9), and liver abscess (1/9). The chest radiography was abnormal in nine patients. Mycobacterium tuberculosis was isolated from ascites in two out of four patients, gastric aspirates in three, sputum in three, and intra-abdominal tissue specimens in two. Laparotomy was performed in three patients, laparoscopy in one, and colonoscopy in one.



 

Conclusion:

In Taiwan, abdominal TB should be considered in patients with fever, abdominal pain, weight loss, and abnormal chest radiography. Characteristic computed tomography findings of abdominal TB and a history of exposure to TB contribute to the diagnosis.



 

Key words:

 abdominal tuberculosis children computed tomography Mycobacterium tuberculosis Taiwan