Childhood abdominal tuberculosis: Disease patterns, diagnosis, and drug resistance.

OBJECTIVE: Childhood abdominal tuberculosis may be difficult to diagnose with certainty. Drug resistance adds to the challenge. We present our experience in children with this condition.
METHODS: The case records of all children <18 years of age and diagnosed as abdominal tuberculosis from January 2000 to April 2012 were reviewed. The clinical details; investigative profile (imaging, ascitic fluid analysis, upper gastrointestinal (GI) endoscopy, colonoscopy, and laparotomy); histopathology; microbiology; and response to antitubercular therapy was noted.
RESULTS: Thirty-eight children (median age 11, range 4-16 years) were diagnosed. Multiple intraabdominal sites were involved in 12 (32 %), peritoneal alone in 9 (24 %); isolated intestinal and isolated lymph nodal in 6 (16 %) each. Three children had atypical presentations with gastric outlet obstruction, acute lower GI bleeding, and duodenal perforation, respectively. Overall, definitive bacteriological diagnosis was possible in 47 % (18/38). In others, diagnosis was supported by histopathology (19 %) or other supportive investigations (34 %) along with a response to treatment without relapse. Drug-resistant disease was diagnosed in three (8 %, two multidrug resistant, one extended drug resistant) all of whom presented with a similar clinical picture of large abdominal lymph node masses.
CONCLUSION: Abdominal tuberculosis is still a challenging diagnosis with microbiological confirmation possible only in half of the cases. Atypical presentations and emergence of drug resistance should be kept in mind while managing these patients.