Abstract
BACKGROUND: Abdominal tuberculosis (TB) in pediatric patients is a rare but serious condition that can often be misdiagnosed as malignancy or other abdominal disorders. Intestinal perforation is a rare and life-threatening complication that presents significant diagnostic and therapeutic challenges. CASE REPORT: We report a case of a 13-year-old girl from a TB-endemic region who presented with abdominal distension, weight loss, and vomiting. Initial imaging revealed a multilocular cystic mass in the abdominal cavity, raising suspicion of malignancy. Despite negative results from the tuberculin skin test (TST) and interferon-gamma release assay (IGRA), diagnostic laparoscopy identified severe intestinal adhesions and multiple perforations. Histopathological examination confirmed abdominal TB, and Mycobacterium tuberculosis was detected in peritoneal fluid using Xpert TB-DNA testing. The patient underwent emergency small bowel ostomy and received intravenous antitubercular therapy along with broad-spectrum antibiotics due to concurrent bacterial infection. After clinical improvement, oral anti-TB therapy was initiated, leading to significant resolution of abdominal pathology. CONCLUSION: This case highlights the diagnostic complexity of pediatric abdominal TB, particularly when presenting with an abdominal mass complicated by intestinal perforation. Misleading clinical and imaging findings, along with negative immunological tests, may delay diagnosis. Clinicians in TB-endemic regions should maintain a high index of suspicion for TB in cases of unexplained abdominal masses, especially when routine tests fail to provide a clear diagnosis.