Clinicopathological profile and surgical management outcomes in patients suffering from intestinal tuberculosis

To determine the mode of presentation in intestinal tuberculosis and effectiveness of various surgical procedures adopted in our set up. A descriptive study. Liaquat University Hospital, Hyderabad from June 1996 to May 1998 and Muhammad Medical College Hospital Mirpurkhas, Sindh from April 2002 to March 2004. One hundred-twelve cases of intestinal tuberculosis were studied, which were operated and diagnosis was confirmed on biopsy. Data collection included detailed history particularly duration of symptoms, respiratory complains, dietary habits and bowel habits. At Liaquat University Hospital, 1872 patients were admitted, 386 [20.61%] were operated for abdominal complains [acute, sub-acute or chronic intestinal obstruction or perforation] and 80 [4.27%] were diagnosed as having intestinal tuberculosis. Meanwhile, 624 patients were admitted in Muhammad Medical College Hospital Mirpurkhas. Of these, one hundred-seventy [27.24%] were operated for abdominal pathology and 32 [5.12%] cases were proved as intestinal tuberculosis on histopathology. Out of total 112 cases of intestinal tuberculosis, 64 [57.20%] were male and 48 [42.80%] females. Age ranged from 8 to 55 years with majority in 2nd and 3rd decades. Resection and anastomosis of small gut, limited right hemicolectomy, right hemicolectomy, stricturoplasty, ileostomy, adhenolysis and evacuation of pus were the procedures adopted for management. Post-operative complications were seen in 30.65% of patients with wound infection on top, however, mortality remained 3.57%. The mortality of intestinal tuberculosis is high due to delay in diagnosis and under dosage or irregular anti-tuberculous treatment. In complicated cases, surgery is indicated. When multiple strictures or perforations are present, resection and end to end anastomosis is required. In case of caecal mass [fungating type], right hemicolectomy can be performed and in cases where extensive adhesions are present and there is fear of iatrogenic perforation, in attempts to mobilize right colon, limited right hemicolectomy shall be performed

Live-donor kidney transplantation: a source for tuberculosis transmission?

Between 1976 and 1994, 700 live-donor kidney transplants were carried out at our center. Among these, 28 recipients [4%] developed Tuberculosis 13-92 months [mean, 22.25] after transplantation. This study was conducted to find out the source[s] of infection entailing retrospective analysis of peri-operative data [for both recipients and their corresponding donors] as well as screening the donors with Ziehl- Neelsen [ZN] staining of their urine concentrate. Ten donated kidneys were found to be the source of infection which resulted in urinary TB in 7 recipients and disseminated infection in the remaining three. Treatment was initiated for both recipients and donors. Eight recipients developed chronic rejection. Ultimately, TB was controlled in 9 recipients while the last patient died of disseminated TB. Among the survivors, 4 had a functioning graft and the remaining 5 finally returned to dialysis, 3 of them died of unrelated causes. In all donors, TB infection was controlled. One donor required ballon dilatation for a stricture in the pelvic ureter of the remaining kidney. Donating a tuberculous kidney is hazardous to the immuno-compromized recipients as well as donors. Being a substantial source for post-transplantation TB, potential donors should be screened with ZN staining and PCR [polymerase chain reaction] of their urine concentrates