Pediatric Abdominal Tuberculosis: A Disease with Many Faces

Abdominal tuberculosis has been reported in 0.3-4% of all cases of childhood tuberculosis.It has been reported mainly from developing countries and is rarer in children as compared to adults.The commonest age group affected is 9-14 years.Abdominal pain, fever and weight loss are the most frequent symptoms on presentation and diagnosis is often delayed by 4-6 months.There is a variability in the distribution of the disease within the abdomen reported from different centres and multiple abdominal sites are frequently involved.Overall, the spectrum of disease in children is different from adults, peritoneal and lymph nodal involvement being more common than gastrointestinal disease.Chest x-ray shows pulmonary involvement in up to 25% even in the absence of symptoms and 1/3 rd have history of contact with an infected adult.Abdominal imaging is an important preliminary investigation and helps in guiding further evaluation.It's important to try and establish bacteriological and/or histopathological confirmation by obtaining appropriate samples (ascitic fluid, endoscopic biopsies, imaging-guided aspiration from lymph nodes, omentum etc. depending on involved site), however it's possible in only 23-47% cases and one may often have to resort to a therapeutic trial.Standard anti-tuberculous drugs are generally effective and are given for 9-12 months.A proper follow-up is important and the improvement should be assessed both subjective improvement and by objective parameters (such as endoscopic healing and resolution of imaging features).Surgery is reserved for patients who have developed a perforation or obstruction not responding to medical management.