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Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay
Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626328/ https://www.ncbi.nlm.nih.gov/pubmed/31338118 http://dx.doi.org/10.1186/s13017-019-0252-3 |
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author | Abu-Zidan, Fikri M. Sheek-Hussein, Mohamud |
author_facet | Abu-Zidan, Fikri M. Sheek-Hussein, Mohamud |
author_sort | Abu-Zidan, Fikri M. |
collection | PubMed |
description | Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%. |
format | Online Article Text |
id | pubmed-6626328 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66263282019-07-23 Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay Abu-Zidan, Fikri M. Sheek-Hussein, Mohamud World J Emerg Surg Review Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%. BioMed Central 2019-07-12 /pmc/articles/PMC6626328/ /pubmed/31338118 http://dx.doi.org/10.1186/s13017-019-0252-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Review Abu-Zidan, Fikri M. Sheek-Hussein, Mohamud Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
title | Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
title_full | Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
title_fullStr | Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
title_full_unstemmed | Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
title_short | Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
title_sort | diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626328/ https://www.ncbi.nlm.nih.gov/pubmed/31338118 http://dx.doi.org/10.1186/s13017-019-0252-3 |
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