This document discusses abdominal tuberculosis (TB), which involves the GI tract, peritoneum, lymph nodes, or solid organs like the liver and spleen. It describes the types of intestinal TB (primary vs secondary), presentations, investigations, and treatments. Primary intestinal TB develops in an unexposed person from infected milk, while secondary TB arises from reactivation of dormant lesions. Symptoms include fever, weight loss, abdominal pain, diarrhea, and distension. Diagnosis involves lab tests showing anemia and inflammation as well as imaging studies. Treatment is a full course of anti-TB drugs, with surgery only for complications like obstruction or perforation.

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