Tuberculosis: A rare cause of acute abdomen in pediatric patients - surgical considerations

Abstract

Background: Abdominal tuberculosis (ATB) is a rare presentation of tuberculosis (TB) in pediatric patients, and its diagnosis can be challenging. This study aimed to analyze the role of surgery in patients with ATB presenting with acute abdomen. Methods: We conducted a retrospective analysis of pediatric patients under 18 years of age who underwent surgical intervention for acute abdomen (AA) and were diagnosed with ATB at a tertiary-care center in Latin America between June 2003 and March 2023. The diagnosis was confirmed through histopathology or bacteriological analysis. Demographics, clinical presentation, diagnostic methods, and operative findings were collected, and surgical procedures and postoperative outcomes were assessed. Results: Fifteen patients were included in the study. Symptoms and signs were nonspecific. Imaging studies revealed ascites, adenopathies, and intestinal wall thickening, among other findings. Histopathological examination with identification of caseating granulomas proved essential for diagnosis. The peritoneal form was the most frequent presentation, followed by the intestinal type. There were no differences between stoma reversal surgery performed during or after treatment. Complications were observed in 73 % of cases, with intestinal perforation being the most common one. Conclusion: Accurate diagnosis of ATB in pediatric patients with acute abdomen is crucial to avoid unnecessary surgeries. Surgery in acute ATB is indicated to manage intestinal complications however surgical management should be approached cautiously. Conservative procedures, such as biopsies and drainage, are recommended when intraoperative findings reveal ATB. Level of evidence: Level III, Retrospective study

Keywords

• Abdominal tuberculosis
• Acute abdomen
• Tuberculosis diagnosis
• Abdominal tuberculosis surgery
• Complications
• Children