Abdominal TB

1. Dr. Md. Majedul Islam
FCPS(Surgery)
Assistant Professor
Abdominal Tuberculosis

2. Tuberculosis
 Also called Koch’s disease(Robert Koch
discovered the organism in 1882)
 Organism : Mycobacterium tuberculosis
 Also M.bovis(unpasteurised milk or milk product).

3. Abdominal TB
 By definition: Abdominal TB include involvement
of : -
 GI tract
 Peritoneum
 Lymphnodes
 Solid viscera(Liver, spleen, pancrease)

4. Intestinal TB Types
 It is of two types depending upon **route of
infection, and **immune response
 1. Primary intestinal T.B
 2. Secondary intestinal T.B

5. Primary intestinal T.B
 develops in a previously unexposed and
therefore unsensitized person.
 The source of infection is exogenous i.e. taking
milk infected with mycobacterium Bovis.

6. Secondary intestinal T.B
 Arises in a previously sensitized host.
 It may follow shortly after primary tuberculosis,
but more commonly it arises from reactivation of
dormant primary lesion many decades after initial
infection.
 The source of infection may be blood born,
swallowing coughed up infected material, direct
spread from adjacent organ or through lymph
channels of infected lymph nodes.
 In 25-50% of cases there is accompanying active
pulmonary tuberculosis.

7. Intestinal TB Types
 Pathologically 2 types: Ulcerative &
Hypertrophic(hyperplastic) or stricturing
 Ulcerative

8. Histological picture
 The characterstic histological picture of TB is
 Presence of : * epithelioid cell granuloma *
lymphocytes, plasma cell, Langhans giant cell
with central casseous necrosis.

9. Presentation of GI TB
 General :
1. Fever,
2. Night sweat,
3. anorexia & weight loss,
4. failure to thrive(Children),
5. Malaise, fatigue, lethargy &
6. lassitude.

10. Presentation(Contd)
 Abdominal:
1. Pain,
2. Distension,
3. Diarrhoea(Due to ulcerated lesion &
malabsorption),
4. Constipation(Due to obstruction)
5. Lump(More commonly in Right iliac fossa)

11. Sign of Abdominal TB
 Pallor
 Malnutrition
 Abdominal lump and organomegaly
 Ascities(Peritoneal TB)
 Abdomen is distended, doughy and mildly tender.

12. Acute presentation of GI TB
 Intestinal obstruction(caused by Strictures,
hypertrophic lesion and adhesion)
 Bowel perforation(occur at the site of the ulcer
and usually proximal to a stricture)

13. Differential Diagnosis
 Lump in the RIF:
 Appendicular lump
 Appendicular abscess
 Ca Appendix
 Ca cecum
 Crohns Disease
 Lymphoma
 Tubo ovarian mass

14. investigation
 Anemia
 Hypoalbuminemia
 Raised ESR
 Elevated CRP
 CXR(Pulmonary TB- Cavitation)
Plain X ray abdomen :
 calcified mesenteric lymph nodes
 Ground glass appearance(ascities)
 Dilated loops with air fluid level and free air

15. Barium Study
 A barium meal and follow-through (or small bowel
enema) shows
 strictures of the small bowel, particularly the
ileum,
 typically with a high subhepatic caecum
 with the narrow ileum entering the caecum
directly from below upwards in a straight line
rather than at an angle

16.  Diagnostic Laparoscopy reveals the typical
picture of
1. tubercles on the bowel serosa,
2. multiple strictures,
3. a high caecum,
4. enlarged lymph nodes,
5. areas of caseation and ascites.
Advantages:
Take biopsy, collect asitic fluid for study

17. Ascitic fluid study in TB found
 Clear straw coloured exudate
 Protein > 3G/L
 Lymphocyte predominant>1000/mL
 Serum ascities albumin gradient less than 1.1
 Adenosine deaminase > 33U/L
 PCR for MTB or Gene expert (More specific)

18.  Colonoscpy: advantages are visualization and
taking biopsy

19. Treatment
 All patient with GI TB should receive a full course
of ATT(anti tubercular therapy)
 A combination drug is always used to reduce the
emergence of resistance
 Both 6 month(4 drugs 2 months followed by 2
drug 4 months) or 9 months(3 drug 3 months
followed by 2 drug for 6 months) are equally
effective.

20. Surgery
 Indication:
1. Obstruction because of stricture
2. Perforation and peritonitis
3. Bleeding (Rare)
Surgical procedure: Limited resection