Clinico-radiological assessment of peritoneal manifestations of abdominal tuberculosis with pathological correlation

Background: Peritoneal tuberculosis (PTB) is a significant manifestation of abdominal tuberculosis (TB), common in endemic regions like India, and often mimics other intra-abdominal diseases, leading to diagnostic delays. Radiological imaging plays a central role in detection, but confirmation requires pathological or microbiological correlation. Aims and Objectives: This study aims to evaluate the clinico-radiological features of PTB and correlate them with pathological findings to improve diagnostic accuracy and guide timely management. Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of Radio-diagnosis, Maharani Laxmi Bai Medical College, Jhansi, from December 2023 to March 2025, including 55 patients aged 15–70 years with suspected PTB. Clinical assessment, ultrasound, and contrast-enhanced computed tomography were performed, documenting ascites, peritoneal/omental thickening, mesenteric changes, and lymphadenopathy. When indicated, image-guided biopsy or ascitic fluid analysis (adenosine deaminase [ADA], serum ascites albumin gradient [SAAG], Ziehl–Neelsen staining, Löwenstein–Jensen culture, reverse transcription-polymerase chain reaction [RT-PCR]) was done. Data were analyzed using the Statistical Package for the Social Sciences, v22.0, with Chi-square tests. Results: Mean patient age was 37.69 years, with a slight female predominance (54.55%). Wet type PTB was most common (49.09%), followed by dry (27.27%) and fibrotic (10.91%). Mesenteric involvement and lymphadenopathy were universal, whereas omental thickening was seen in 96.36%. RT-PCR positivity was 18.18%, and raised ADA with low SAAG was observed in 63.64%. Pulmonary TB coexisted in 61.82% of patients. Conclusion: Combining clinical evaluation with characteristic imaging findings, supported by ADA and RT-PCR, enhances early diagnosis of PTB. This approach can prevent misdiagnosis, facilitate timely therapy, and reduce unnecessary surgical interventions.