What are the symptoms and signs of abdominal tuberculosis (TB) in physical examination?

Abdominal Tuberculosis: Clinical Presentation and Physical Examination Findings

Abdominal tuberculosis presents with variable and non-specific symptoms that commonly mimic inflammatory bowel disease, malignancy, and other intra-abdominal pathology, making clinical suspicion essential for diagnosis. 1

Key Clinical Symptoms

The most common presenting symptoms include:

• Anorexia (84% of cases) - one of the most frequent complaints 2
• Abdominal pain (84% of cases) - typically chronic and non-specific in character 3, 2
• Weight loss (72% of cases) - significant unintentional weight loss is characteristic 2
• Fever - often low-grade and may be accompanied by night sweats 1
• Chronic diarrhea or altered bowel habits - due to intestinal involvement 3

Physical Examination Findings

Abdominal Examination

• Abdominal tenderness - the most common physical finding on examination 2
• Palpable mass in the right lower quadrant - particularly with ileocecal involvement, which is the most common site of gastrointestinal TB 3, 2
• Ascites (42% of cases) - may present as wet type with free fluid, dry type with adhesions, or fibrotic type with omental thickening 3, 2
• Abdominal distension - from ascites, obstruction, or mass effect 3
• Hepatomegaly or splenomegaly - may be present with peritoneal involvement 3

Systemic Signs

• Fever - documented in many cases, though not universal 1
• Cachexia and wasting - from chronic disease and malabsorption 3
• Pallor - from chronic anemia 3

Anatomical Distribution

• Ileocecal region and terminal ileum - most common site of involvement (60-90% of gastrointestinal TB cases) 1, 3
• Peritoneum - second most common site, presenting with ascites or peritoneal thickening 3
• Mesenteric lymph nodes - often enlarged and matted 3

Important Clinical Pitfalls

A normal chest radiograph does NOT exclude abdominal tuberculosis - concomitant pulmonary lesions are present in less than 25-32% of cases. 3, 2 This is a critical point as clinicians may falsely reassure themselves with negative chest imaging.

The presentation mimics Crohn's disease closely, particularly in the ileocecal region. 1 Features more suggestive of TB include: night sweats, positive tuberculin skin test, abdominal lymphadenopathy, transverse ulcers on colonoscopy, and patulous ileocecal valve. 1

Complications Requiring Urgent Recognition

• Intestinal obstruction - from strictures or ileocecal narrowing 1
• Perforation - particularly in ulcerative type TB, requiring surgical intervention 1
• Malabsorption - especially with extensive small bowel involvement and strictures 3
• Fistula formation - including perianal fistulae 3

Clinical Context

High clinical suspicion is mandatory in patients from endemic areas (Asia, Africa) or with HIV/AIDS, immunosuppression, or immigration history. 1 The combination of anorexia, abdominal pain, weight loss, and ascites should immediately raise suspicion for abdominal TB. 2

The diagnosis requires complementary imaging (ultrasound showing ascites and lymphadenopathy; CT showing bowel wall thickening, mesenteric lymph nodes, and peritoneal involvement) and often invasive procedures like colonoscopy with biopsy or laparoscopy, as the paucibacillary nature makes microbiological diagnosis challenging. 4, 2