Digestion

Abdominal Tuberculosis

Abdominal Tuberculosis

, also known as Gastrointestinal TB, is a recurring problem in the developing world. So much so that the World Health Organization categorizes it as one of the most important communicable diseases in the world.

Tuberculosis has always been associated with the lungs which is medically known as extrapulmonary tuberculosis. However, abdomen is also affected in about 11% of the patients suffering from the disease. The prevalence of the disease is especially seen in individuals with the Acquired Immuno Deficiency Syndrome (AIDS). The good news is that it is curable if detected early.

Gastrointestinal TB has a bacterial etiology and belongs to the Mycobacterium genus. About one third of the world’s population carries it asymptotically. The bacteria enters the gastrointestinal tract through blood or by swallowing of infected sputum or spreads from infected lymphnodes. About 3 million people are reported to die each year from TB related complications. Of that number, about 1-3% has the abdominal version.

The disease could occur at any age but the age group most commonly affected is the one belonging to the young adults. The most common sites to be affected in the gastrointestinal tract are the terminal ileum, ileocaecal region, the colon and the jejunum. It is characterized by the presence of a mass in the ileocaecal region or in the small bowel.

Organs affected by Abdominal Tuberculosis

Gastrointestinal TB affects the following body parts:

  • Gastrointestinal tract.
  • Peritoneum (The membranous lining on the abdominal cavity and other abdominal organs).
  • Lymph nodes.
  • Solid visceral organs like the liver, pancreas and spleen.
  • It is very rarely that this version of tuberculosis is seen in the duodenum, stomach and esophagus.

Types of Abdominal Tuberculosis and their symptoms

    This disease is grouped depending on the characteristics of the lesions they produce. The three types of lesions are as follows:

  • Ulcerative TB

    : This form of TB is synonymous with ulcerous lesions and generally presents itself with chronic diarrhea which is indicative of malabsorption of nutrients in the intestine.

  • Hypertrophic TB

    : This form of TB results in the enlargement of an abdominal organ like the colon. There is no change in the constituent cells, rather the size of the organ increases. Colonic tuberculosis is generally presented with the symptom of bleeding from the rectum.

  • Stricturous TB

    : Strictourous lesions are mostly formed by the formation of scar tissues arising from the healed tissues of the ulcerative lesions. They result in constrictions or narrowing of the gastrointestinal tract. This type of TB generally exists with the symptoms of intestinal obstruction, abdominal pain, abdominal swelling, vomiting, irregular bowels and bloating.

The above three types may also exist in combinations like ulcero-constrictive or ulcero-hypertrophic tuberculosis. When the disease involves the peritoneum it may lead to ascities which is the accumulation of fluids in between the membranous cavity of the abdominal lining.

Diagnosis

The symptoms are misleading and can be the same for other gastrointestinal problems like inflammatory bowel disease, colonic malignancy etc. Hence, it becomes imperative to test for the discussed condition and confirm the diagnosis. The different diagnostic methods used in this case are as follows:

  • Blood tests (to look for a drop in hemoglobin or an elevated ESR)
  • Ultrasonography
  • CT scan of the abdomen
  • X-rays
  • Barium Edema
  • Ascitic fluid aspiration and examination
  • Colonoscopy

Treatment of Abdominal TB

  • Abdominal TB is treated with antibiotic drugs like rifampicin, ethambutol, isoniazid and pyrazinamide. The treatment has to be continued for a period of 6 months or more.
  • Surgically, it is treated with procedures like enteroenterostomy ( a surgical connection between two segments of the intestine) or iliotransverse colostomy ( a surgical procedure to create an opening for urine and feces to be discharged from the body through an outlet in the abdominal wall).

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