ABSTRACT
Background: Abdominal tuberculosis includes tuberculous infection of gastrointestinal tract, mesentery, lymph nodes and omentum, peritoneum and solid organs like liver and spleen. The initial clinical presentations are nonspecific and no single laboratory investigation is pathognomonic. Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests though rewarding is expensive. Moreover, abdominal tuberculosis with an acute abdomen presents as an enormous challenge to the surgeon.Methods: This one-year prospective observational study of 25 patients who presented with intestinal tuberculosis at the Department of General Surgery, NIMRA Medical College from February 2019 to January 2020. The causes of intestinal tuberculosis were determined along with clinical profile and were monitored for outcome based on the morbidity and mortality.Results: Among the 25 patients, all had intestinal tuberculosis on the basis of operative findings and histopatholoigcal reports. Age of the patients ranged between 9 to 70 years; majority (75%) were in the age group of 20 to 40 years. Female to male ratio was 1.7:1. The commonest operative findings were hyperplastic ileocaecal tuberculosis (16%), followed by strictures (20%), and perforations (24%). The overall mortality was 8% due to sepsis and septic shock.Conclusions: Intestinal tuberculosis is a common problem presenting to general surgical units in the developing countries, often in an acute form. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis, in order to minimize complications.
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.