Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay
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(2019) 14:33
REVIEW
Open Access
Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay Fikri M. Abu-Zidan1*
and Mohamud Sheek-Hussein2
Abstract Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%. Keywords: Tuberculosis, Extrapulmonary, Abdominal, Diagnosis, Surgery, Algorithm
Introduction Charles Dickens (1812–1870) has described tuberculosis (TB) as “a dread disease in which struggle between soul and body is gradual quiet and solemn, that day by day, and grain by grain, the mortal part wastes and withers away.” This may be true till now. Tuberculosis is one of the top 10 causes of death, globally. In 2017, ten million people developed tuberculosis, with an estimated 1.3 million deaths [1]. Furthermore, about one-quarter of the global population has latent tuberculosis infection [2]. Currently, the management is even more complex with the emerging of multi drug-resistant bacteria. * Correspondence: [email protected] 1 Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain 17666, United Arab Emirates Full list of author information is available at the end of the article
Extrapulmonary tuberculosis occurs in about 20% of tuberculosis [3] while abdominal tuberculosis constitutes about 10% of extra-pulmonary tuberculosi
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