ABSTRACT
Background: Gastrointestinal tuberculosis is one of the commonest sites of extra pulmonary involvement. Most of the studies in the literature are on abdominal tuberculosis as a whole, which to a certain extent is responsible for confusion. Hence this study aims at a fresh look into Gastro intestinal tuberculosis as a separate entity. Aim and objectives: 1) to analyze the clinical features of Gastro Intestinal Tuberculosis. 2) To study the pathological features.3) to evaluate the role of surgery and to choose procedures in management of this disease. Methods: A total of 32 patients were included into this prospective study and divided into 4 groups based on the type of presentation namely, Obstruction – 18, Mass- 4, Perforation – 4 & Atypical – 6. They were subjected to thorough clinical evaluation and appropriately investigated. Results: Pain abdomen was the commonest symptom, 94% of the patients. 56% of the patients with obstruction. Commonest abdominal sign was abdominal distension, 66% of the patients. Ileocaecal region was the most common site, 50% of the patients. Ulcerative form was the most common gross pathology, 59% of the patients. Patients were subjected to either conservative management – 5 patients, Or Surgery , emergency in 17 patients and elective in 10 patients, depending on the Mode of presentation. Limited Ileocaecal resection was done in 9 patients and Right Hemicolectomy in 4 patients. Stricturoplasty was done in 8 patients. Complications were more common in emergency surgery. Conclusion: Patients commonly present with complications as intestinal obstruction. Ileocaecal region is the commonest site of disease .Conservative mode of management is preferable in patients not presenting with complications. Patients presenting with acute obstruction or perforation need emergency surgery.
ABSTRACT
Background: The main type of tuberculosis of interest to any hospital- based surgeon is intestinal, the clinical presentation of which varies from one of an acute abdomen to one of a protracted cause of ill health and morbidity with a notorious reputation for poor response to therapy, both conservative as well as surgical. Low socio- economic status and malnutrition in our country are very important causes of the high prevalence of pulmonary tuberculosis, and with superadded problems of overcrowding and poor access to good sanitation and neglect for medical attention, extra pulmonary forms of tuberculosis also form a sizeable proportion of the case load of tuberculosis. The major source of infection is the open untreated case of pulmonary tuberculosis. Methods: Presented here is a brief account of hospital- based study of the presentation of 50 cases of abdominal tuberculosis and its management in both the acute as well as chronic setting, carried out at the S.C.B Medical College, Cuttack, Odisha. Results: In our study 40% patients presented with signs of intestinal obstruction, 6% with perforative peritonitis, 34% with diffuse or well defined lump and 54% with ascites. All these patients underwent biochemical, radiological and endoscopic investigations. 26 patients underwent surgical treatment, Out of these 26 patients, 14 were operated in emergency and 12 were operated electively, Emergency surgeries were performed after correction of fluid electrolyte imbalance. Of the 14 emergency cases, 3 patients underwent resection anastomosis of small bowel. 6 patients underwent right hemicolectomy for iieocaecal tuberculosis. Conclusion: In this study 60% patients had an acute and subacute presentation and 40% patients had a chronic presentation.