Clinical and Diagnostic Characteristics of Abdominal Tuberculosis in Real-World Practice: Which Diagnostic Modalities Most Frequently Establish the Diagnosis?
Supervising author: J. K. Schloeter Rebolledo
Underlined: presenting author · Presented by Keyla Estefania Becerra Mogollon
Background
Abdominal tuberculosis (TB) remains diagnostically challenging because of its nonspecific clinical presentation and variable yield of microbiologic testing. Definitive diagnosis may therefore require tissue sampling, particularly when initial testing is nondiagnostic.
Methods
We conducted a retrospective descriptive case series of 17 adult patients (age 18 years or older) with confirmed abdominal TB evaluated at Hospital Universitario Erasmo Meoz in Cúcuta, Colombia, from 2014 to 2024. Clinical manifestations, imaging, microbiologic testing, invasive procedures, and histopathologic findings were reviewed. Diagnostic yield was described for acid-fast bacilli (AFB) smear, mycobacterial culture, molecular testing, and histopathology.
Results
Presenting manifestations were nonspecific, including fever (70.6%), diarrhea (58.8%), weight loss (58.8%), ascites (35.3%), and constipation (23.5%). Imaging was positively documented in 41.2% of cases. Microbiologic testing demonstrated variable yield: AFB smear was positive in 20.0% of patients tested, culture in 50.0%, and molecular testing in 71.4%. In 10 of 17 cases (58.8%), no microbiologic test established the diagnosis. An invasive diagnostic procedure was performed in 14 patients (82.4%). Histopathologic evaluation was obtained in 16 patients (94.1%) and demonstrated diagnostic findings in all 16 (100%). Granulomatous inflammation and intra-abdominal adhesions were identified in 10 (58.8%) and 11 (64.7%) patients, respectively.
Conclusion
Abdominal TB presented with nonspecific clinical manifestations and variable microbiologic diagnostic yield in this cohort. Tissue-based evaluation was central to definitive diagnosis, particularly when microbiologic testing was nondiagnostic. These findings highlight the importance of maintaining clinical suspicion for abdominal TB in adult patients with unexplained abdominal disease and considering tissue diagnosis when initial microbiologic evaluation does not establish the diagnosis.