The Great Masquerader: A Case Series Unveiling the Diverse Presentations of Abdominal Tuberculosis in a Middle Eastern Tertiary Hospital

SurgeryObjective:Rare disease Background:Abdominal tuberculosis (TB) remains a diagnostic challenge because of its diverse clinical manifestations and ability to mimic other surgical conditions.The global burden of TB, particularly in low-and middle-income countries, further compounds this diagnostic challenge.Delayed diagnosis contributes to substantial morbidity, especially in regions where TB is endemic. Case Reports:This case series highlights 4 distinct presentations of abdominal TB, emphasizing early recognition and multidisciplinary management.The diagnosis was established or considered presumptively based on a combination of clinical assessment, radiological findings, intraoperative observations, microbiological testing, and histopathological examination.Despite standard anti-tuberculous therapy initiation in all patients, 2 experienced progressive clinical deterioration and subsequently died.The cases included: 1. Ileocecal TB causing small bowel obstruction with terminal ileal perforation in a patient previously treated with intravesical Bacille Calmette-Guérin (BCG) therapy for bladder cancer, in whom disseminated BCG infection could not be definitively distinguished from Mycobacterium tuberculosis infection.2. Retroperitoneal TB presenting as a cystic mass initially suspected to represent an ovarian cyst or soft tissue neoplasm.3. Peritoneal TB mimicking recurrent peritoneal metastases in a patient with a history of colorectal cancer, in whom TB polymerase chain reaction and acid-fast bacilli staining results were negative; histopathology and multidisciplinary assessment supported a presumptive diagnosis.4. A retroperitoneal tuberculous abscess with vertebral involvement requiring percutaneous drainage and microbiological confirmation. Conclusions:This case series underscores the importance of maintaining a high index of suspicion for abdominal TB, particularly when clinical and radiological findings mimic malignancy.Histopathological assessment and multidisciplinary collaboration remain essential when microbiological investigations are inconclusive.