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Abdominal tuberculosis can affect the gastrointestinal tract, the peritoneum, the liver, and the pancreas. Before effective antituberculous agents were available, 70% of patients with advanced pulmonary disease acquired gastrointestinal tuberculosis by swallowing infected secretions. However, fewer than 25% of cases with gastrointestinal tuberculosis have radiographic evidence of pulmonary tuberculosis. Tuberculosis can involve any gastrointestinal site from the oropharynx to the anus. Patients can present with nonhealing ulcers of the tongue or oropharynx, or nonhealing sockets after tooth extraction. An adjacent caseous node might result in esophageal stricture with obstruction, tracheoesophageal fistula formation, and rare fatal hematemesis from an aortoesophageal fistula. Patients might have ulcerative or hyperplastic lesions in the stomach or gastric outlet obstruction. Duodenal involvement may lead to symptoms of peptic ulcer or obstruction. Perforation, obstruction, enteroenteric and enterocutaneous fistula, massive hemorrhage, and severe malabsorption may follow small bowel involvement. The most typical site of enteric tuberculosis is the ileocecal area producing symptoms of pain, anorexia, diarrhea, obstruction, hemorrhage, and a palpable mass. Patients with anal tuberculosis might have ulcers, perianal warty growths, and fistulas.
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