Diagnosis of abdominal tuberculosis

Mr Rai and Mr Thomas (December 2003 JRSM¹) outline the difficulties in diagnosing abdominal tuberculosis and suggest that early laparoscopy may aid diagnosis and reduce time for it to be made. In their case series of 36 patients the mean duration of presenting complaint was 18 months. The diagnosis of abdominal TB should be in clinicians' minds even in the acute setting. Recently an Asian woman aged 18 was referred to the gynaecologists with right iliac fossa pain. She spoke little English and history-taking was difficult. She was anaemic and the white cell count and C-reactive protein were raised. The surgeons were then consulted, and diagnosed acute appendicitis. Under anaesthesia a mass could be felt arising from the pelvis on the right, and a low midline incision was made. The entire peritoneal cavity was caked with tuberculous nodules with a normal-looking appendix and ovaries. Unfortunately, the patient died in intensive care a few days later. On further questioning of relatives it was found that the patient had arrived in the UK only a fortnight previously, after her marriage to a UK citizen, and had been experiencing abdominal pain and other symptoms for the past three months. In this patient the diagnosis could have been made at laparoscopy, avoiding the laparotomy. More importantly the case highlights the need for thorough history-taking and inclusion of abdominal TB in the differential diagnosis.