Case study on abdominal tuberculosis

Priya1, Mercy Ezhil Rani2

1Staff Nurse, Kauvery Hospital, Hosur, Tamil Nadu

2Clinical Educator, Kauvery hospital, Hosur, Tamil Nadu

Abstract

Abdominal tuberculosis (TB) is a rare but significant form of extra pulmonary TB, often presenting with nonspecific symptoms that mimic other gastrointestinal conditions. This case report describes a 16-year-old female is presenting with abdominal pain, distension, and weight loss.

Introduction

Abdominal Tuberculosis (TB) involves the following sites single or in combination: gastrointestinal tract, peritoneum, visceral organs, and intra-abdominal lymph nodes. As a form of extra pulmonary TB (EXPTB), abdominal TB can occur in the presence or absence of active pulmonary TB. Abdominal TB is relatively rare; representing 1% to 3% of global TB cases, and the rate varies worldwide as a function of overall EXPTB rates within geographic locations. Abdominal TB estimates range from approximately 13% of the EXPTB cases in India to 6% of the EXPTB cases in the United States. Diagnosis is challenging and often delayed due to its nonspecific presentation. Abdominal TB responds well to standard anti tuberculous drugs when diagnosed early, with surgery only required in cases that develop complications (e.g., strictures or obstruction) or that are unresponsive to medical therapy. High clinical suspicion, early initiation of anti-tuberculous therapy, and involvement of an inter professional team are necessary for reducing morbidity and mortality.

Case Presentation

Patient came with the complaints of intermittent fever for two months, history of weight loss more than 12 kgs in a period of two months.

History

  • Past medical history: No previous TB history, not a known case of DM/ HT/ BA
  • Family History: No family history of TB
  • Vaccination: BCG at birth, Vaccination done as per schedule.

Clinical Examination

Conscious, oriented, afebrile

BP: 100/70mm Hg; PR: 118/ min; RR: 22/min;

SpO2: 98%, Temperature: 98 °F

Investigations

CECT abdomen: Thickening of distal ileum extending up to IC junction, diffuse peritoneal thickening with nodularity noted, mild omental haziness noted, mild omental haziness noted, clumping of small bowel loops with few loops adherent to anterior abdominal wall, intel  op free fluid noted in pelvis region, multiple enlarged necrotic mesenteric lymph nodes noted, thickening of right transverse colon with mildly dilated caecum and ascending colon noted, bilateral per ovarian adhesions, s/o TB peritonitis needed HPE correlation

Screening of chest shows: Pulmonary TB and its sequelae.

InvestigationResults
Hb9.5g/dl
TC6030 / Cumm
Platelet Count361000 / Cumm
Serum Urea22.1 mg/dl
Sr.Creatinine0.5 mg/dl
Sodium137 mmol/L
K+4.7 mmol/ L
Total Bilirubin0.6 mg/dl
SGOT21U/L
SGPT12u/l
PTT14.2 sec
PT11.4 sec
INR1.26
  1. Mantoux test: Positive (15 mm induration)
  2. Abdominal ultrasound: Ascites with septations, thickened bowel loops
  3. CT abdomen: Thickening of ileocecal junction, mesenteric lymphadenopathy with central necrosis, omental caking
  4. Ascetic fluid analysis: Exudative, lymphocytic predominance, high ADA (adenosine deaminase) – 65 IU/L
  5. Gene Xpert (from ascetic fluid): Positive for Mycobacterium tuberculosis, Rifampicin sensitive

CT chest revealed multiple lesions in both lungs along with a mild left-sided pneumothorax. Pulmonology consultation was obtained. In view of the pneumothorax and the anticipated low diagnostic yield from bronchoscopy, the patient was advised to undergo colonoscopy with biopsy for further evaluation.

After obtaining informed written consent and completing pre-anaesthetic assessment and bowel preparation, the patient underwent colonoscopy under IV sedation. The procedure revealed ulcerations at the ileocecal valve, raising suspicion for abdominal Koch’s. Multiple biopsies were obtained for histopathological examination.

The post-procedure period the patient was stable. The patient tolerated a normal diet well, passed stools without difficulty, and remained stable. The biopsy report was awaited at the time of discharge.

Diagnosis

Abdominal tuberculosis (ileocecal involvement and tuberculous peritonitis)

Medical Treatment

Started on Category I Anti-Tubercular Therapy (ATT) under DOTS:

Category 1 therapy for abdominal tuberculosis refers to the standard first-line anti-tuberculosis treatment used for newly diagnosed, drug-sensitive TB cases. It includes a 6-month regimen:

Intensive phase (2 months): Isoniazid, Rifampicin, Pyrazinamide, Ethambutol

Continuation phase (4 months): Isoniazid and Rifampicin

  • Provide analgesics for abdominal pain as ordered.
  • Encourage warm compresses to ease muscle tension and pain.
  • Monitor and manage ascites — record abdominal girth and weight daily.

Nutritional Support

  • High-protein, high-calorie diet to promote healing and weight gain.
  • Small, frequent meals to reduce discomfort.
  • Supplement with vitamins and minerals, especially Vitamin B6 with isoniazid.
  • Monitor weight and dietary intake regularly.

 

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