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Emergency Medicine55 papers

Tuberculosis of abdomen

Last edited: 4/14/2026

Overview

Tuberculosis of the abdomen refers to extrapulmonary tuberculosis affecting intra-abdominal organs, often presenting with nonspecific symptoms such as abdominal pain, fever, and weight loss. It can involve various organs including the peritoneum, omentum, and gastrointestinal tract, complicating diagnosis and management 111.

Diagnosis

  • Clinical Presentation: Abdominal pain, fever, weight loss, and nonspecific signs like rebound tenderness 1.
  • Laboratory Tests: Leukocytosis may be present 2.
  • Imaging: Contrast-enhanced CT scans are crucial for diagnosis but must be weighed against risks like contrast-induced nephropathy 89.
  • Diagnostic Procedures: Diagnostic peritoneal tap and peritoneal lavage can confirm diagnosis by identifying granulocytes, bacteria, or acid-fast bacilli in fluid 1516.
  • Limitations: Plain abdominal radiography is rarely diagnostic 14.

    • Management

  • Antibiotic Therapy: Initiate empirical antituberculous therapy (e.g., isoniazid, rifampin, ethambutol, pyrazinamide) pending culture results 11.
  • Surgical Intervention: Consider surgery for complications like bowel obstruction, abscess drainage, or necrotic tissue removal 7.
  • Monitoring: Close monitoring of intra-abdominal pressure in cases requiring open abdomen post-surgery 4.
  • Pain Management: Early administration of analgesia may be considered despite concerns about altering physical examination findings; practice varies 1213.

    • Special Populations

  • Pregnancy: Laparoscopy can be performed safely under certain conditions; accurate diagnosis of appendicitis and other conditions is critical 11.
  • Elderly: Emergency laparoscopy is increasingly used but requires careful assessment of frailty and comorbidities 3.
  • Comorbidities: Consider risks of contrast-enhanced CT in patients with renal impairment due to potential contrast-induced nephropathy 89.

    • Key Recommendations

  • Initiate empirical antituberculous therapy promptly in suspected cases of abdominal tuberculosis (Evidence: Moderate) 11.
  • Utilize contrast-enhanced CT scans judiciously, considering risks like contrast-induced nephropathy, especially in patients with renal impairment (Evidence: Moderate) 89.
  • Perform diagnostic peritoneal tap or lavage when clinical diagnosis is uncertain to confirm intra-abdominal tuberculosis (Evidence: Weak) 1516.
  • Consider emergency surgical intervention for complications such as abscesses or bowel obstruction (Evidence: Expert opinion) 7.
  • Tailor pain management strategies considering both patient comfort and potential impact on diagnostic accuracy, acknowledging variability in current practice (Evidence: Weak) 1213.

    • References

    1 Michael M, Kleophas A, Keitel V, Flügen G, Bernhard M. [Acute Abdominal Pain in the Emergency Department]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS 2021. link 2 Bolat H, Teke Z. Primary omental torsion with massive necrosis A case of uncommon surgical emergency. Annali italiani di chirurgia 2020. link 3 Costa G, Fransvea P, Podda M, Pisanu A, Carrano FM, Iossa A et al.. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study. Updates in surgery 2020. link 4 Guetta O, Brotfain E, Shaked G, Sebbag G, Klein M, Czeiger D. Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy. Langenbeck's archives of surgery 2020. link 5 Popivanov G, Cirocchi R, Popov G, Stefanovski P, Andonova R, Kjossev K et al.. An analysis of missed cases with surgical emergencies admitted in non-surgical departments. Case series and а review of the literature. Il Giornale di chirurgia 2020. link 6 De Simone B, Ansaloni L, Sartelli M, Coccolini F, Napoli JA, Catena F. The Video-Consulting Emergency protocol: a proposition from the World Society of Emergency Surgery members for the initial management of non-traumatic acute abdomen. Minerva chirurgica 2019. link 7 Samsonov VT, Ermolov AS, Gulyaev AA, Yartsev PA, Levitsky VD, Rogal MM. [Laparoscopy in emergency abdominal surgery]. Khirurgiia 2019. link 8 De Simone B, Ansaloni L, Sartelli M, Gaiani F, Leandro G, De' Angelis GL et al.. Is the risk of contrast-induced nephropathy a real contraindication to perform intravenous contrast enhanced Computed Tomography for non-traumatic acute abdomen in Emergency Surgery Department?. Acta bio-medica : Atenei Parmensis 2018. link 9 Lehtimäki T, Juvonen P, Valtonen H, Miettinen P, Paajanen H, Vanninen R. Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial. European radiology 2013. link 10 Cherry-Bukowiec JR, Miller BS, Doherty GM, Brunsvold ME, Hemmila MR, Park PK et al.. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training. The Journal of trauma 2011. link 11 Kilpatrick CC, Orejuela FJ. Management of the acute abdomen in pregnancy: a review. Current opinion in obstetrics & gynecology 2008. link 12 Nissman SA, Kaplan LJ, Mann BD. Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation. American journal of surgery 2003. link01412-5) 13 Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians. The American journal of emergency medicine 2000. link90114-1) 14 Plewa MC. Emergency abdominal radiography. Emergency medicine clinics of North America 1991. link 15 Rao RN, Ravikumar TS. Diagnostic Peritoneal Tap. International surgery 1977. link 16 Evans C, Rashid A, Rosenberg IL, Pollock AV. An appraisal of peritoneal lavage in the diagnosis of the acute abdomen. The British journal of surgery 1975. link

    Original source

    1. [1]
      [Acute Abdominal Pain in the Emergency Department]. — Michael M, Kleophas A, Keitel V, Flügen G, Bernhard M Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS (2021)
    2. [2]
      Primary omental torsion with massive necrosis A case of uncommon surgical emergency. — Bolat H, Teke Z Annali italiani di chirurgia (2020)
    3. [3]
      The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study. — Costa G, Fransvea P, Podda M, Pisanu A, Carrano FM, Iossa A et al. Updates in surgery (2020)
    4. [4]
      Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy. — Guetta O, Brotfain E, Shaked G, Sebbag G, Klein M, Czeiger D Langenbeck's archives of surgery (2020)
    5. [5]
      An analysis of missed cases with surgical emergencies admitted in non-surgical departments. Case series and а review of the literature. — Popivanov G, Cirocchi R, Popov G, Stefanovski P, Andonova R, Kjossev K et al. Il Giornale di chirurgia (2020)
    6. [6]
      The Video-Consulting Emergency protocol: a proposition from the World Society of Emergency Surgery members for the initial management of non-traumatic acute abdomen. — De Simone B, Ansaloni L, Sartelli M, Coccolini F, Napoli JA, Catena F Minerva chirurgica (2019)
    7. [7]
      [Laparoscopy in emergency abdominal surgery]. — Samsonov VT, Ermolov AS, Gulyaev AA, Yartsev PA, Levitsky VD, Rogal MM Khirurgiia (2019)
    8. [8]
      Is the risk of contrast-induced nephropathy a real contraindication to perform intravenous contrast enhanced Computed Tomography for non-traumatic acute abdomen in Emergency Surgery Department? — De Simone B, Ansaloni L, Sartelli M, Gaiani F, Leandro G, De' Angelis GL et al. Acta bio-medica : Atenei Parmensis (2018)
    9. [9]
      Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial. — Lehtimäki T, Juvonen P, Valtonen H, Miettinen P, Paajanen H, Vanninen R European radiology (2013)
    10. [10]
      Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training. — Cherry-Bukowiec JR, Miller BS, Doherty GM, Brunsvold ME, Hemmila MR, Park PK et al. The Journal of trauma (2011)
    11. [11]
      Management of the acute abdomen in pregnancy: a review. — Kilpatrick CC, Orejuela FJ Current opinion in obstetrics & gynecology (2008)
    12. [12]
      Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation. — Nissman SA, Kaplan LJ, Mann BD American journal of surgery (2003)
    13. [13]
      Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians. — Wolfe JM, Lein DY, Lenkoski K, Smithline HA The American journal of emergency medicine (2000)
    14. [14]
      Emergency abdominal radiography. — Plewa MC Emergency medicine clinics of North America (1991)
    15. [15]
      Diagnostic Peritoneal Tap. — Rao RN, Ravikumar TS International surgery (1977)
    16. [16]
      An appraisal of peritoneal lavage in the diagnosis of the acute abdomen. — Evans C, Rashid A, Rosenberg IL, Pollock AV The British journal of surgery (1975)
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