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 REPORT
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.

Keywords: Case Reports; Diagnosis, Differential; Gastroenterology; Signs and Symptoms; Tuberculosis, Abdominal