RM Butal, IH Cua Saint Luke’s Medical Center, Quezon City
Significance: Tuberculosis (TB) remains a major global health problem with extrapulmonary tuberculosis (EPTB) accounting for 1 in 5 registered TB cases. Abdominal TB is the 6th most prevalent presentation of EPTB. It often mimics many other gastrointestinal diseases and confers significant morbidity and mortality, thus, a high index of suspicion is important.
Clinical Presentation: First case is a 21/F initially presenting as acute appendicitis who was re-admitted after 2 weeks for small intestinal obstruction. Second case is a 31/M admitted for epigastric pain who subsequently developed massive hematochezia on his 6th hospital day. The 3rd case is a 19/M with 4-month history of undocumented fever, afternoon sweats and progressive abdominal distention.
Management: All 3 cases were diagnosed via histopathology findings. MTB PCR was also taken for the 2nd and 3rd cases. Standard anti-TB regimen of isoniazid, rifampicin, pyrazinamide and ethambutol were given to all three cases. The first case however, underwent exploratory laparotomy, right hemicolectomy with ileostomy and creation of mucus fistula.
Recommendation: Abdominal tuberculosis presents with protean manifestations, neither clinical signs alone, nor radiologic, endoscopic, bacteriologic or histopathologic findings provide a gold standard by themselves in the diagnosis. Thus, it is recommended that knowledge of the different manifestations and investigative findings be coupled with high index of suspicion to avoid missed diagnoses and prevent avoidable morbidity and mortality.
Keywords: Case series, abdominal tuberculosis, extrapulmonary tuberculosis