Abdominal tuberculosis presenting with massive ascites: A case series

Abstract

Background: The abdomen is the sixth most common site of extra-pulmonary tuberculosis. The clinical manifestations of abdominal tuberculosis are varied and non-specific. It is known to mimic a variety of abdominal disorders and may be missed, leading to delay in appropriate management and poor prognosis. We describe massive ascites in three patients with abdominal tuberculosis.
Methods: Case records of three patients admitted to the medical wards of the University of Benin Teaching Hospital (UBTH) with complaints of cough, abdominal swelling and marked weight loss were reviewed.
Results: Diagnosis was made in all three cases with the ascitic fluid yielding mycobacterium tuberculosis on Ziehl Nielsen staining. Histology of the peritoneal tissue in the patients showed centre areas of caseations, aggregates of epitheloid cells, rim of lymphocytes, Langhans giant cells and fibroblasts which were in keeping with features of tuberculosis. All patients were treated using four anti-tuberculosis drugs and they responded to the treatment. In one of the three however, the patient required laparotomy.
Conclusion: Patients who present with non-specific abdominal symptoms and massive ascites should be investigated for abdominal tuberculosis.

Keywords: Abdominal tuberculosis, Massive ascites, Mycobacterium tuberculosis, Nigeria.