Abstract / Summary
Abstract Background Abdominal tuberculosis (ATB) is one of the most challenging forms of extrapulmonary tuberculosis because of its nonspecific clinical presentation and radiological resemblance to gastrointestinal malignancies and inflammatory bowel diseases. We conducted a Six-year retrospective observational study to evaluate the radioclinical characteristics, diagnostic approaches, and clinical outcomes of patients with abdominal tuberculosis at a tertiary referral hospital in Somalia. Methods This retrospective study included 286 patients diagnosed with abdominal tuberculosis between January 2019 and December 2024. Patients were classified as confirmed ATB when diagnosis was established by histopathology, microbiological culture, GeneXpert MTB/RIF, or a combination of these methods, and as presumed ATB when diagnosis was based on compatible clinical presentation, characteristic radiological findings after exclusion of alternative diagnoses. Demographic characteristics, clinical manifestations, computed tomography (CT) findings, diagnostic procedures, treatment strategies, and clinical outcomes were analyzed using SPSS version 26. Associations between categorical variables were assessed using Pearson's chi-square test, with P < 0.05 considered statistically significant. Results Among the 286 patients, 226 (79.0%) had confirmed abdominal tuberculosis, while 60 (21.0%) were classified as presumed cases. The majority were young adults, with the highest proportion belonging to the 20–39-year age group. Multiple-site abdominal involvement was the predominant radiological pattern (236/286, 82.5%), followed by isolated peritoneal tuberculosis (47/286, 16.4%). Paracentesis was the most frequently performed diagnostic procedure (186/286, 65.0%). Initial radiological assessment correctly identified abdominal tuberculosis in 243 patients (85.0%), whereas 43 patients (15.0%) were initially misdiagnosed, including 39 (13.6%) as malignancy, and 4 (1.4%) as Crohn's disease, before microbiology-pathological confirmation. Most patients improved following anti-tuberculosis therapy (233/286, 81.5%), while 39 (13.6%) died and 14 (4.9%) were lost to follow-up. Prolonged symptom duration was significantly associated with the need for surgical intervention (P < 0.05). Conclusions Abdominal tuberculosis remains a major diagnostic challenge in tuberculosis-endemic, resource-limited settings because of its nonspecific clinical and radiological features. An integrated diagnostic approach combining clinical assessment, contrast-enhanced CT, histopathological examination, microbiological testing, and molecular diagnostics is essential for improving diagnostic accuracy and reducing unnecessary surgical intervention. These findings provide important evidence to strengthen the diagnosis and management of abdominal tuberculosis in Somalia and other high-burden settings.