Twenty-four patients having a median (range) age of 30 (19–59) years were studied. Thirteen (54.3%) were females. All were expatriate workers, and none was a UAE national (Table 1). The incidence of abdominal tuberculosis was 0.6 per each 100,000 population. The most common presenting symptoms were abdominal pain (95.8%), malaise (79.2%) and loss of appetite (79.2%). Fever was present only in nine patients (37.5%) while night sweats were present only in six patients (25%). The duration of symptoms ranged between two days to three years having a median duration of two months. The most common clinical findings were abdominal tenderness (75%) and distension (37.5%) (Table 2). Only two patients presented with a clear picture of peritonitis (8.3%)
Table 1
Demography of 28 patients with abdominal tuberculosis who were treated at Al-Ain Hospital during the period of January 2011 to December 2018
Variable | Value |
Gender | |
Female | 13 (54.2%) |
Male | 11 (45.8%) |
Age | 30 (19–59) |
Nationality | |
Philippines | 6 (25 %) |
Ethiopia | 5 (20.8 %) |
India | 5 (20.8 %) |
Bangladesh | 3 (12.5 %) |
Oman | 2 (8.3 %) |
Others | 3 (12.5 %) |
Data are presented as median (range) or number (%) as appropriate |
Table 2
Symptoms and signs of 28 patients with abdominal tuberculosis who were treated at Al-Ain Hospital during the period of January 2011 to December 2018
Variable | Number (%) |
Symptoms | |
Abdominal pain | 23 (95.8) |
Malaise | 19 (79.2) |
Loss of appetite | 19 (79.2) |
Nausea | 16 (66.7) |
Loss of weight | 15 (62.5) |
Diarrhea | 13 (54.2) |
Fever | 9 (37.5) |
Night sweats | 6 (25) |
Vomiting | 5 (20.8%) |
Signs | |
Tenderness | 18 (75) |
Abdominal distension | 9 (37.5) |
Guarding | 8 (33.3) |
Ascites | 8 (33.3) |
Rigidity | 2 (8.3) |
Negative bowel sounds | 2 (8.3) |
Abdominal tuberculosis was suspected in 13 patients on admission (54.2%). The second common suspected diagnosis was acute appendicitis (16.7%) (Table 3). Two patients were discovered to have an associated abdominal tuberculosis during elective surgery when operated for another cause (gallstones and colonic adenocarcinoma).
Table 3
Suspected diagnosis of 24 patients with proven abdominal tuberculosis who were treated at Al-Ain Hospital during the period of January 2011 to December 2018
Suspected diagnosis | Number (%) |
Abdominal tuberculosis | 13 (54.2) |
Acute appendicitis | 4 (16.7) |
Abdominal mass | 3 (12.5) |
Intestinal obstruction | 1 (4.2) |
Peritonitis | 1 (4.2) |
Biliary colic | 1 (4.2) |
Abdominal wall abscess | 1 (4.2) |
C-reactive protein (CRP) was raised in 16 patients (80%), leukocytosis was present in 3 patients (13.63%), raised ESR in 4/8 patients (57.14%), anemia in 12 patients (50%), lymphocytopenia in 3 patients (13.6%), and thrombocytosis in 8/22 patients (36.3%) (Table 4)
Table 4
Blood investigations of 24 patients with abdominal tuberculosis who were treated at Al-Ain Hospital during the period of January 2011 to December 2018
Blood investigations | Value |
CRP (normal value <5 mg/l) | 25.1 (2-239) |
≥5 mg/l | 16/20 (80%) |
White bold cell count (normal value 4.5-11x109/l) | 6.65 (3.6–13.7) |
>11x109/l | 3/22 (13.6%) |
ESR (0–20/hour) | 27 (12–68) |
> 20/hour | 4/8 (50%) |
Hemoglobin (normal value 12.1-20g/dl) | 11.7 (7-16.5) |
< 12.g/dl | 12 (50%) |
Lymphocytes (normal value 1000 − 3.500 /µl) | 1700 (130–2800) |
< 1000 µL | 3/22 (13.6%) |
Platelets (normal value 140-400x1000/ml) | 338 (156–711) |
>400x1000/ml | 8/22 (36.3%) |
Data are presented as median range or number (%) as appropriate. Percentages are calculated from available data. |
Chest X-ray was abnormal in only three patients (12.5%). Two had pleural effusion while the third had left apical pleural thickening and scaring suggesting pulmonary tuberculosis. Ultrasound was done in 13 patients. It showed abnormal findings in 11 patients. Sonographic findings included free intraperitoneal fluid in 4 patients, intraperitoneal soft tissue masses in three patients, intraperitoneal lymph nodes in three patients, thickened bowel in two patients, thickened omentum in two patients, encysted ascites in one patient (Fig. 1), abdominal wall mass in one patient and scarred kidneys in one patient.
Abdominal CT scan was done in 14 patients. Abdominal tuberculosis was suggested only in three patients, one had an omental cake and adenopathy, the second had a necrotic mass anterior and below the duodenum suggestive of a necrotic tuberculous adenopathy (Fig. 2), and the third had a thickened bowel with suspected pulmonary tuberculosis. The CT scan were generally nonspecific which included intra-abdominal lymphadenopathy in four patients, ileocecal mass in three patients, thickened bowel in three patients, free intraperitoneal fluid in two patients, pleural effusion in two patients, abdominal cocoon with dilated bowel in one patient, thickened omentum in one patient, hepatic calcification in one patient, and iliopsoas abscess connected with a sinus to an inflamed terminal ileum in one patient (Fig. 3).
Diagnosis was confirmed by histopathology showing caseating granuloma in 15 patients (62.5%), two of these patients had acid fast bacilli on the slides. Immunological assays suggested the diagnosis in 7 patients (29.2%). One patient grew mycobacterium tuberculosis (4%). The workup of one patient was non-conclusive and had a therapeutic trial to confirm the diagnosis (4%).
Table 5 shows the type of abdominal tuberculosis. The most common was gastrointestinal tuberculosis in 13 patients (54.2%) followed by the free wet peritonitis (ascites) in five patients (20.8%).
Table 5
Type of abdominal tuberculosis in 24 patients who were treated at Al-Ain Hospital during the period of January 2011 to December 2018
Type | Number (%) |
Gastrointestinal | 13 (54.2) |
Wet peritonitis (ascites) | 5 (20.8) |
Dry peritonitis | 4 (18.2) |
Encysted ascites | 1 (4.2) |
Lymphadenopathy | 1 (4.2) |
Thirteen patients had surgical operations. Five had laparoscopy, two were diagnostic for biopsies, three were therapeutic, all were converted to open surgery. Two of these patients had a right hemicolectomy while the third had cocoon encapsulating the small bowel, which was released. Six patients had laparotomy, two of them were in another hospital and then transferred to Al-Ain Hospital to continue their management. Two needed only a biopsy, two had small bowel resection anastomosis and two had right hemicolectomy. Two patients had abdominal wall surgery, an incision and drainage of an abscess and an excision of a mass. Three patients had postoperative complications (12.5%); one patient had wound infection, another had pleural effusion, and a third had a sinus formation. All patients had quadruple anti-tuberculous therapy which included Isoniazid, Rifampin, Ethambutol, and Pyrazinamide for a minimum of six months. The patients stayed in the hospital for a median range of 6.5 (0–21) days and were followed up for a period of (6–12) months. One of them needed readmission complaining of vomiting which resolved. None of our patients died.