Abdominal TuberculosisAbdominal Tuberculosis

Dr. Irshad Ali Khan

PGT GST III

PIMS

EpidemiologyEpidemiology

Every year: 7-10 million new cases 6 % deaths

Abdominal T.B is the commonest extra pulmonary manifestation

Incidence in west in on rise due to Immigrants Aging HIV infection

Extra-pulmonary manifestations Non HIV patients: 10-15 % HIV patients: 50%

Re-emergence of the intestinal variant due to Incomplete therapy Multi drug resistance Increased incidence of HIV infection

Routes of abdominal KocksRoutes of abdominal Kocks

Direct Ingestion Infected sputum (M. tuberculosis) Dietary products e.g. unpasturised milk, M.

bovis) Haematogenous spread

Secondry to pulmonary TB Direct extension from the contiguous organ

e.g through fallopian tubes

PathogenesisPathogenesis

After ingestion the organism is trapped in the Peyer’s patches It undergoes inflammatory enlargementLeads to transverse mucosal ulcerationElement of endarteritis Ultimately may lead to bowel perforation

Mesenteric lymph node infectedEnlarge and caseate Intra abdominal abscess formation

PathogenesisPathogenesis

Fibrosis may follow leading to napkin ring strictures

Extensive inflammation of submucosa and subserosa at ICJ → hyperplastic form

Adjacent bowel loops, mesentery, and nodes adhere → a mass → intestinal cocoon

PathogenesisPathogenesis

Peritoneal involvement takes the form of the numerous tubercles on the peritoneum and intestine

Omentum thickens to form a rolled-up omentum

Ascites is usually present

PathogenesisPathogenesis

Haematogenous involvement presents as multiple parenchymal abcesses with organomegaly of the liver, spleen, and pancreas.

Contagious spread from the Spine Genitourinary tract Parietal wall Retro peritoneum

PeritonealPeritoneal Wet type: Ascites

Generalized Loculated

Dry plastic Mesenteric thickening Caseous lymph node Fibrous adhesions

PeritonealPeritoneal Fibrotic fixed type

Mass formation of the omentum Matting of the bowel loops

Acute primary peritonitis

Mesenteric Involvement Mass Abscess Nodal

Solid Organ

Liver, Spleen, Pancreas Localized abscess Multiple miliary form

Pre and post ATT Therapy