Incidence of abdominal tuberculosis in 186 cases of acute abdomen presenting in our surgical emergency department

Among 186 cases of Acute Abdomen, determining the frequency of abdominal tuberculosis patients with their outcome. A prospective case study from January, 2009 to June 2010. Surgical Unit-V District Headquarters [Teaching] Hospital, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome and histopathology was entered on a specially designed Performa, compiled and analyzed. During the period of study, 186 patients presented in the surgical emergency with complaints of acute abdomen out of which 54 [29.03%] were of abdominal tuberculosis. Mean age of presentation was 27.3 years. Operative findings showed predominance of ileocaecal hypertrophic tuberculosis [tuberculous mass] in 18 [33.33%] patients, followed by tuberculous adhesions, ileal strictures and plastic gut.The surgical procedures were performed according to their intra-abdominal findings out of which right hemicolectomy with ileocolic end to end anastomosis in 18 [33.33%] patients remained the commenest procedure performed followed by segmental ileal resection anastomosis, ileostomy and stricturoplasty. 20 [37.04%] patients reported to have post-operative complications in which wound infection in 7 [12.96%] remained the highest occurring postoperative complication followed by intra-abdominal collection, anastomotic leakage and septicemia. Mortality rate among the patients of abdominal tuberculosis in this study remained 5.56%. Complicated abdominal tuberculosis is the most common pathology of acute abdomen. By proper management of pre-complicated abdominal tuberculosis, this disastrous stage of disease resulting in so morbidity and mortality can be reduced

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

Conservative surgical management of intestinal tuberculosis.

Forty-seven proved cases of intestinal tuberculosis admitted to the surgical ward of MKCG Medical College, Berhampur from 1985 to 1987 were subjected to laparotomy. The common pathology found were tubercles over the peritoneum, multiple strictures of intestine, ileocaecal mass, perforation of the intestines, bands and adhesions and mesenteric node involvement. The patients with acute abdomen were operated in emergency and rest as an elective procedure. Conservative surgeries like stricturoplasty, local intestinal resection, perforation closure, by-pass procedures and local ileocaecal resection were done in most of the cases and only in 2 cases right hemicolectomy was done. Biopsy was taken from the viscera, peritoneum and mesenteric nodes. Postoperative mortality was 6.4%, mostly due to toxaemia and fluid and electrolyte imbalance. Postoperative complications in most of the cases were wound infection. All were given a short course of antituberculosis regimen containing INH, rifampicin and ethambutol. Patients were followed up to one year and definite improvement was noted.