Abdominal tuberculosis: Analysis of clinical features and outcome of adult patients in southern Taiwan

Background: Abdominal tuberculosis remains a serious health threat. This retrospective report aimed to analyze patients after the development of the tuberculosis control program by the Center of Disease Control (Taiwan) in January 2000. The study was conducted at the Chang Gung Memorial Hospital-Kaohsiung, Taiwan. Methods: Between January 2000 and December 2006, we evaluated 14 adult patients with abdominal tuberculosis by reviewing their clinical information, therapeutic methods and outcomes. Diagnosis of abdominal tuberculosis was made based on clinical features of abdominal infection with microbiological results from culture, acid-fast bacilli stain and polymerase chain reaction for Mycobacterium tuberculosis and/or histopathological confirmation from biopsy and ascites. Results: Tuberculous peritonitis and intestinal tuberculosis were the most common type of infections followed by hepatic tuberculosis, and intra-abdominal tuberculoma. 35.7% of these patients had the coexistence of extra-abdominal infection. The most common clinical symptoms and signs were abdominal pain, abdominal distension, ascites and body weight loss. Fever was found in 35.7% of patients and peritoneal signs were noted in 7.1%. Immunocompromised states and old age are relevant to adult abdominal tuberculosis. Overall, patients were diagnosed by bacteriology (35.7%), biopsy materials from laparotomy (42.8%), liver biopsy (14.3%), and biopsy materials from colonoscopy (7.2%). Patients were cured after taking antituberculous drugs for at least 6 months without relapse during regular follow-up for at least 2 years. However, three patients died of sepsis and decompensated liver cirrhosis during treatment. Conclusion: Extra vigilance in dealing with patients who present with unexplained abdominal conditions is the key to the diagnosis of abdominal tuberculosis. Early diagnosis, early antituberculous therapy and surgical treatment of the associated complications are essential for the survival of the patient.