Abstracts
2002 Digestive Disease Week

# 100619 Abstract ID: 100619 Surgical Management of Abdominal Tuberculosis (ATB)
Imran Hassan, Emmanouil Brilakis, Rodney L Thompson, Florencia G Que, Rochester, MN

Abdominal tuberculosis (ATB) imitates a variety of intraabdominal pathologies. Recent reports suggest an increased incidence of ATB in the United States (US), particularly in high-risk groups. AIM: To review the spectrum of ATB and its surgical management at a tertiary referral center in the United States. METHODS: The medical records of patients treated for ATB at our institution between January 1992 and June 2001 were reviewed retrospectively. RESULTS: Eighteen patients were diagnosed with ATB by microbiologic and/ or histologic examination. The 10 men and 8 women had a mean duration of symptoms of 4 months (range 1-24 months). Five were US born and 13 were foreigners (7 Asians and 6 Africans). The US born patients with ATB as compared to the foreign-born patients were 1) older (mean age 74 vs. 35 years), 2) more likely to have chronic medical illnesses (80% vs. 7%), and 3) had concomitant pulmonary tuberculosis (60% vs. 0%). Abdominal pain (76%), weight loss (64%), fever (35%) and abdominal distension (24%) were the most common presenting findings. Preoperative investigations revealed anemia (94%), hypoalbuminemia (55%), elevated erythrocyte sedimentation rate (50%) and elevated transaminase and alkaline phosphatase levels (33%). PPD was positive in 43% and negative in 57%. Computed tomography (CT) was the most frequent imaging modality (88%); findings suggestive of ATB were mesenteric/ omental stranding (50%), ascites (37%), and retroperitoneal lymphadenopathy (31%). Seventeen of the 18 patients required operative intervention; while one underwent CT-guided drainage of a psoas abscess. Laparoscopy was useful for diagnosis in 8 patients; laparotomy was performed for complications of ATB in 6 patients and to obtain a tissue diagnosis in 3 patients. Sites of involvement included peritoneum (8), gastroduodenal (2), ileo-cecal (2), tubo-ovarian (2) and small bowel mesentery and retroperitoneal lymph nodes and liver in one patient each. CONCLUSIONS: ATB continues to represent a diagnostic challenge to clinicians. In native Caucasians, ATB is primarily a disseminated disease in elderly, debilitated patients with chronic illnesses. Among foreign-born individuals, ATB occurs in young, immunocompetent patients from endemic areas. Characteristic CT findings should be evaluated for ATB in the appropriate clinical setting. Laparoscopy is an effective modality for diagnosis of peritoneal tuberculosis.