Abdominal XXXX in East Birmingham--a 16 year study.

@entity1 @entity353 @entity3639 @entity490 @entity378
Abdominal @entity378 , although rare, occurs mainly in immigrants from the Indian subcontinent. Such @entity1 comprise 13.5% of our local population and contributed 90% of a series of 72 @entity1 presenting in the last 16 years; a local disease incidence of 1:6000 for Asian immigrants. @entity1 and @entity1 were equally affected, but on average @entity1 were much younger. Diagnosis was made from one month to 10 years after immigration. No clinical feature was diagnostic, but @entity490 , night sweats and @entity353 occurred in more than half the @entity1 . The erythrocyte sedimentation rate (ESR) was elevated in 95% and no @entity1 tested had a negative Mantoux test. In 20 @entity1 diagnosis was by clinical suspicion and response to therapeutic trial. In 52, including 39 who had a laparotomy, histological and culture material was obtained but these @entity1 fared no better. Only one organism was resistant (to @entity3639 ) and rapid response to chemotherapy was the rule. Successful outcome was not related to the type of presentation, operative findings or specific chemotherapeutic agents. We would suggest that in Asians presenting with difficult-to-diagnose abdominal symptoms accompanied by malaise, raised ESR and a positive Mantoux test, a therapeutic trial of anti-tuberculous therapy should precede diagnostic laparotomy.
