Abdominal tuberculosis in Chingola-Zambia: Pattern of presentation

Abstract

Background: Before the advent of the HIV pandemic abdominal tuberculosis was seen rarely but it is now being seen with increasing frequency in the surgical departments. The HIV has, also to a large extent, altered its presentation. This study was aimed at determining the pattern of presentation of abdominal tuberculosis seen at Nchanga hospitals in Chingola district on the Copperbelt province of Zambia

Methods: This was a prospective study of all the patients who presented to the surgical department at Nchanga North and South with tuberculosis of the abdomen between April 1994 and March 1999. The patients’ symptoms, physical findings, investigations, treatment and follow up findings were recorded and analyzed.

Results: During 5-year period, 35 patients presented to the hospitals’ department of surgery with abdominal Tuberculosis. There were 19 males and 16 females. There ages ranged from 7 to 75 years with a mean age of 32 years. Abdominal pain (91.4%), weight loss (71.4%) and fever (63.0%) were the commonest symptoms. Physical examination revealed abdominal tenderness in all the patients and abdominal masses in 62.9% of the patients. Of the 35 patient, 31 (88.6%) were found to be HIV positive. Ultra sound scan was performed on 28 patients and ascites of varying amounts was found in all but one patient. Diagnostic Laparotomy was done in 17 patients and apart from one patient, the rest had tuberculous peritonitis. There were 12 patients who had extra abdominal TB; 11 had tuberculous lymphadenitis one had pulmonary tuberculosis. All the patients were started on anti-Tb treatment. Twenty six (74.3%) had a good response in that they subjectively felt well within two weeks of starting treatment and14 of these patients returned to work or normal life by the end of two months of treatment. The other 12 took longer than two months to return to normal life. However 14.3% of the patients had a prolonged hospital stay and 11.4% died. Of those who initially responded well, five died six months to one year later of other effects of AIDS.

Conclusion: Abdominal tuberculosis is HIV related the majority of our patients. It responds well to treatment in most of the patients.