Asma Mushtaq, Samia Naz, Mohammad Shehram, Javeria Nayyar.
Abdominal tuberculosis in children: a diagnostic challenge.
Pak J Med Health Sci Jan ;13(4):953-6.

Background : Abdominal tuberculosis (TB) may affect any part of the intestinal tract, the peritoneum and the hepatobiliary system. It can present with various clinical manifestations, frequently resembling other diseases. Aim : To assess the various clinical manifestations , how to diagnose and outcome of abdominal TB in children. Methods: It was a descriptive cross-sectional study and was conducted at Pediatric Medicine Department, The Children's Hospital and The Institute of Child Health, Lahore. A total of 30 patients were enrolled in the study who were diagnosed with abdominal TB between July, 2017 to December, 2017 . All patients less than 15 years of age and who presented with abdominal TB during this period were enrolled in this study. Complete history of all patients, such as clinical manifestations, detailed examination, various laboratory tests, drugs given and outcome was noted . Statistical analysis by SPSS version 20 was done. Results : Out of thirty patients (15 boys and 15 girls ) with abdominal tuberculosis, the mean age was 10.2 years . The commonest presenting complaint was abdominal distension in 29 (96%) patients followed by abdominal pain in 26(86% ), fever in 26(86%), weight loss in 23(76%) patients and seven (23%) patients had surgical abdomen. Five patients had coexisting disseminated tuberculosis and one had tuberculosis meningitis (TBM) . One patient was a case of coexisting Down syndrome, one of oculocutaneous albinism and one of neurofibromatosis -1. Abdominal tuberculosis involved abdominal lymph nodes in 26(86%), peritoneum in 19(63%), ascities in 23 (76%) , gastrointestinal tract in 22(73%), liver in 26(86%) and spleen in 15(50%) patients. Ascitic fluid examination of 18 patients revealed exudative picture with predominantly lymphocytes. Explolatory laparotomy was done in 2 patients. Diagnosis was done by ascetic fluid findings showing exudative picture, abdominal imaging, positive montoux test, positive history of contact with a TB patient , along with good response to anti -tuberculous therapy . Conclusion : Abdominal pain and distention are the commonest clinical presentations followed by fever and weight loss. As single confirmatory test is not readily available , therapy can be started on the basis of clinical presentations and relevant laboratory parameters.

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