Abdominal Tuberculosis in Children

Objective To provide an insight into the presentation, diagnosis, and management of gastrointestinal tuberculosis in children. Methods We reviewed the medical records of children who were diagnosed with gastrointestinal tuberculosis, between October 2013 and October 2023. The analysis was performed using descriptive statistics. Results During the study period, 11 of 76 tuberculosis pediatric patients (14.5%) were diagnosed with gastrointestinal tuberculosis. Six of 11 patients (54.5%) were female. The median age of the patients was 60 months (51-205 months). Eight of 11 patients had intra-abdominal lymph node involvement, 3 of 11 patients had intestinal tuberculosis, and 2 of 11 patients had also active pulmonary tuberculosis. Multiple intra-abdominal areas were involved in six patients. Mean duration of symptoms before admission was 60 days (5-180 days). The most common symptoms were abdominal pain (63.7%), weight loss (63.7%), and weakness/fatigue (54.5%). Acid-fast bacilli and tuberculosis polymerase chain reaction were positive in only two patients. Tuberculosis culture positivity was detected in two patients, both of them showed Mycobacterium bovis growth. Necrotizing granulomatous inflammation was the most frequently observed histopathological finding. Anemia was detected in six patients. There was elevated erythrocyte sedimentation rate in eight patients and elevated C-reactive protein in six patients. In one patient, recurrent obstruction symptoms developed due to stenosis of terminal ileum. Clinical cure was achieved with supportive treatment. Conclusion Diagnosis of gastrointestinal tuberculosis is very difficult due to nonspecific clinical and radiological features. Microbiological confirmation of the disease is often challenging. Making a definitive diagnosis requires reliance on strong clinical suspicion, imaging and histopathological findings, microbiological tests, and/or response to treatment.