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Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. They need special expertise, and rarely used in low- and middle-income countries. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Clinical and radiological findings of abdominal tuberculosis are non-specific.
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A high index of suspicion is essential for reaching its diagnosis. It is a great mimicker that has unusual presentations. Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians.