ABSTRACT
Background: The objective of this study is to evaluate diagnosed cases of abdominal tuberculosis (TB) in terms of incidence,manifestation in different age groups, clinical presentations, treatment received (conservative or surgical), lesions foundintraoperatively, and its outcome on follow-ups.Methods: It is a retrospective study with 25 cases of abdominal TB treated at Guru Gobind Singh Hospital, Jamnagar, duringthe period of 2005–2007. Detailed history, physical examination, necessary investigations such as complete blood counts, ESR,urine examination, sputum examination, and radiological investigations were prescribed in all cases. Barium study, Mantouxtest, ascitic fluid examination, and computed tomography scan abdomen were carried out when indicated. Tissue or biopsymaterials were histologically examined. Results were analyzed with patient’s health status.Results: In 25 case series of abdominal TB, the average age of presentation was between 10 and 40 years with definitemale predominance (male:female = 3:2). Most of the patients belonged to low socioeconomic class which, in turn, reflectsovercrowding, undernourishment, bad sanitation, and poor hygiene in living conditions. In our study, ESR was raised in morethan 90% of patients. Abdominal pain was the most common presenting symptom followed by anorexia, fever, and vomiting.About 25% of patients were having TB foci in lung either active or healed lesion. Uncorrected anemia, malnutrition, andpulmonary TB were all contributory to poor prognosis and prolonged morbidity. Anti-TB drugs gave most satisfactory resultsin our patients.Conclusions: Koch’s abdomen is a clinical entity with varied clinical presentation. It is very common in tropics and maypresent with complications. Most of the patients are cured with conservative treatment and anti-TB drugs. Surgery is requiredin case of complications only. No drug-resistant cases have been found in this study. Investigations have played major role inconfirmation of disease.
ABSTRACT
A 50-year-old male, truck driver, met with an accident with blunt steering wheel injury to the abdomen with no external marks ofinjury over the abdominal wall. He had severe abdominal pain with tossing up in bed. As the abdomen showed no external marksof injuries, strikingly, abdominal palpatory findings were prominent with severe tenderness in the left side umbilical and pelvicregions. He had consumed heavy food with liquids within an hour before the accident. He collided with another stationary lorry;thus, he received massive blow to his abdomen with the steering wheel. He displayed the signs of hemorrhagic shock on arrivalto the emergency care. Computed tomography scan confirmed moderate hemoperitoneum with multiple bowel perforations. Onexploratory laparotomy, multiple jejunal and ileal loops were found completely avulsed from the base of the mesentery, makingthem completely devascularized along with dismembered descending colon from the sigmoid. Resection of nonviable smallbowels and end-to-end jejunoileal anastomosis was done. Colocolic anastomosis was performed after adequate descendingcolon mobilization with protective loop ileostomy in the right lower quadrant. The patient had developed wound infection; hence,he was put on daily dressing. Gradually, the patient improved and was discharged with functioning ileostomy.