Abdominal tuberculosis an experience at Ayub teaching hospital Abbottabad

Abdominal tuberculosis is one of the common diseases in our country. This study was performed at Surgical A Unit Ayub Teaching Hospital Abbottabad from August 2006 to December 2007 to asses the clinical presentation of abdominal tuberculosis and its management. All patients presenting to outpatient department with clinical feature suggestive of abdominal tuberculosis were included in the study. They were investigated. On the basis of clinical presentation, patients were divided in two groups. Patients with acute abdomen [peritonitis, intestinal obstruction] were prepared for laparotomy and operated upon. Required surgical procedure performed and tissue diagnosis was obtained. Patients with sub-acute obstruction, chronic pain abdomen and mass abdomen with out peritonism were managed conservatively. These patients were started on anti TB drugs on the basis of clinical and laboratory assessment. Empiric therapeutic trial was conducted for at least for 3 months with standard four drugs regimen. They were sent home on 9 month course of Anti TB drugs and were advised to come for follow up twice a month. On reassessment good clinical response was considered abdominal tuberculosis and anti TB continued with monthly follow up. In case of no response patients were operated. Required surgical intervention performed and tissue was taken to establish diagnosis. Detailed history, family history, examination findings, results of investigations, operative findings of the histologically proven cases of abdominal tuberculosis were recorded on a separate proforma and analyzed. Amongst 76 patients majority were females 52 [68.4%]. Most of the patients were young with mean age of 34 years. Abdominal pain was the most common presentation 73 [96%] followed by fever and anorexia. Tender lower abdomen as found in 53 [70%] patients and mass abdomen was found in 35 [46%]. Family history of TB was present in 20 [26%]. Fifty three [70%] patients underwent laparotomy. Bands and adhesion was the most frequent finding on laparotomy. Abdominal TB is more common in female and abdominal pain fever and nausea are the most common presentations

Abdominal tuberculosis: a surgical perspective

To document the clinical presentation, operative findings, surgical procedures and complications of abdominal tuberculosis. Retrospective study. This study was conducted in Surgical Unit II of Bolan Medical Complex Hospital, Quetta during August 2001 to August 2006. This study included patients, who presented with clinical features of intestinal obstruction. They were either known cases of abdominal tuberculosis or diagnosed at the time of laparotomy. Tissue biopsy specimen was taken from all the cases for histopathological examination. A total of 7983 patients were admitted during the last 5 years. Among them 294 were admitted with acute or chronic intestinal obstruction. All of them were operated. Two hundred were suffering from abdominal tuberculosis. Majority of them were in their 4th decade of life. The male to female ratio was1:1.63. The most common clinical presentation was the weight loss [88%], abdominal distension [73%] and abdominal pain [46%]. Peroperative findings revealed ileal perforation in 44.0%, multiple adhesions in 26.5% and ileocaecal mass in 14.0%. Resection of gut and primary anastomosis was performed in 38.0% and adhesiolysis in 22.0%. The major cause of morbidity was wound infection [17.0%], faecal fistula [9.5%] and burst abdomen [6.5%]. The mortality was 12.0%. Abdominal tuberculosis is one of the major causes of acute abdomen in developing countries. It affects the people of working age group of the society. It imparts a great deal of morbidity as well as economic loss

Revisión de infección pelviana por actinomices: presentación de un caso clínico / Pelvic actinomycosis review: presentation of a clinical case

La infección por actinomices ha sido llamada "la gran imitadora" en la práctica clínica. La actinomicosis es una infección crónica supurativa debido a gérmenes gram positivos, anaerobios, no esporulados. Habita normalmente en las mucosa oral, gastrointestinal, genitales. Las infecciones oportunistas ocurren cuando se rompen las barreras mucosas, ocasionando la formación de abscesos, fístulas o masas. La actinomicosis tiene tres grandes presentaciones clínicas: cervicofacial, torácica y abdomino-pélvica. Se presenta un caso de actinomices abdomino-pélvica.

Intestinal bleeding and occlusion associated with shiga toxin-producing Escherichia coli 0127: H21

We report a case of a nine-year old boy with vomiting, abdominal pain and fever, who underwent surgery with a diagnosis of appendicitis in Mendonza and from whom a Shiga toxin-producing Escherichia coli (STEC) 0127:H21 strain was recovered. Forty-eight hours after surgery he presented bilious vomiting and two episodes of intestinal bleeding. Loboratory findings included: hematocrit, 35 per cent; blood urea nitrogen, 0.22 g/L. The urinary output was normal. The following day physical examination showed an alert mildy hydrated child, without fever but with distended and painful abdomen. The patient was again submitted to surgery with a diagnosis of intestinal occlusion. Bleeding and multiple adhesions in jejunum and ileum were found. The patient still had tense and painful abdomen and presented two bowel movements with blood; hematocrit fell to 29 per cent and blood urea nitrogen rose to 0.32 g/L. STEC 0127:H21 eae(-)/Stx2/Stx2vh-b(+)/E-Hly(+) was isolated from a stool sample. He was discharged after 10 days of hospitalization and no long-term complications such as HUS or TTP were observed. This is the first report, to our knoweledge, on the isolation of E.coli 0127:H21, carrying the virulence factors that characterize STEC strains, associated to an enterohemorrhagic colitis case. This serotype was previously characterized as a non-classic enteropathogenic E. coli (EPEC). STEC infections can mimic infectious or noninfectious pathologies. Therefore an important aspect of clinical managements is making the diagnosis using different criteria thereby avoiding misdiagnoses which have occasionally led to invasive diagnostic and therapeutic procedures or the inappropriate use of antibiotics.

Camundongos isogênicos A/SNELL, BALB/c e C57BL/6 como modelos biológicos de sepsis intra-abdominal / Inbred mice A/SNELL, BALB/c and C57L/6 as animal models of intra-abdominal sepsis

Com o objetivo de desenvolver modelos biológicos alternativos de sepsis intra-abdominal para estudos experimentais, foram infectados camundongos isogênicos A/ SNELL, BALB/c e C57BL/6, com a bactéria "Escherichia coli", cepa ATCC 117755, sorotipo H7:01:K1. O resultado da determinaçào da DL50 mostrou que para camundongos da linhagem C57BL/6 a dose (3E-5,85 UFC) foi 14 vezes maior do que para camundongos A/SNELL (3E-5,68 UFC), e 12 vezes maior do que para camundongos BALB/c (3xE-5,77). Os exames histopatológicos de orgãos da cavidade abdominal, juntamente com análise do número de leucócitos polimorfonucleares encontrados no lavado peritoneal e em esfregaço sangüíneo, representam parâmetros que podem ser utilizados para avaliação de sepsis intra-abdominal em estudos experimentais (au)

Actinomicosis abdominal / Abdominal actinomycosis

Actimomycosis is a non opportunistic chronic infection caused by a superior bacteria that forms grains in the pus or affected organs. 54 cases have been reported in the last 50 years in the chilean literature, 51 percent were abdominal actinomycoses, 25.5 percent pelvic and 18.5 percent puñmonary. 14 cases have been treated in the last 9 years at San Borja Arriaran. Of these 7 were abdominal (1 parietal and 6 visceral forms) and 4 involved the rectosigmoid; 2 were ileocecal and occurred after an appendicectomy. The presenting picture was of a giant abdominal mass in 2 cases (1 with a colocutaneous fistula), rectal stricture in 1 case, tubo-ovarian abscess with colonic involvement in 1 case, parietal mass in 1 case and a fistula after an appendicectomy in 2 cases. Actinomuces Israelli was found in the histopathological study in three cases and in the bacteriological study in 2. All visceral forms were treated with penicillin plus tetracycline or amoxicillin during 6 to 12 months with complete and permanent recovery. 2 patients required a colonic resection due to a iatrogenic damage and an associated diverticular disease. 3 patients required a colostomy to overcome the obstruction, all of them are asymptomatic and without colostomy 18 months to 8 years later. Due to its different presentation forms, actinomycosis has been called "the great pretender" and in several ocassions the histological or bacteriological diagnosis is not achieved

Manejo de la sepsis intraabdominal / Management of intrabdominal sepsis

La sepsis intraabdominal es una patología frecuente en todo el mundo, con gran repercusión clínica y elevada mortalidad. En la era preantibiótica esta infección era prácticamente mortal y solamente se recuperaban los pacientes que por sus propios mecanismos inmunológicos localizaban los procesos sépticos y en quienes era posible el drenaje espontáneo en algunos o quirúrgicamente en otros. En el presente artículo se pasa revista a la etiología, diagnóstica y tratamiento de esta patología desde una perspectiva contemporánea en una verdadera puesta al día en el tema.

Sepse abdominal e insuficiência de múltiplos órgäos / Abdominal sepsis and multiple organ failure

A insuficiência de múltiplos órgäos é definida como a falência de dois ou mais órgäos e geralmente decorre em conseqüência a traumatismo grave, queimadura, pancreatite, peritonite e sepse. Na grande maioria dos casos ocorre infecçäo grave, acompanhada ou näo de choque séptico e os sinais clínicos de calor (febre, rubor (vasodilataçäo generalizada) e tumor (edema generalizado) estäo presentes. O hipermetabolismo está representado por aumento do gasto energético, aumento do consumo de oxigênio, maior débito cardíaco, maior produçäo de ácido carbônico, maior uso de carboidratos, gorduras e aminoácidos como substrato energético e menor excreçäo urinária de nitrogênio. Com relaçäo à mortalidade, as estatísticas revelam que quando apenas um órgäo é insuficiente, está em torno de 25% a 30%, aumentando para 50% com dois órgäos, 75% com três órgäos e 100% quando quatro órgäos entram em falência. O tratamento visa a correçäo dos distúrbios já instalados e o suporte intensivo aos órgäos íntegros para que näo entre em falência. Neste sentido é fundamental a drenagem de todos os focos sépticos. O suporte metabólico deve obedecer aos princípios de näo fazer mais mal ao paciente, preservar a estrutura e a funçäo dos órgäos, alterar o curso da doença e reduzir a mortalidade

Actinomicosis abdominal / Abdominal actinomycosis

Se presentan 2 casos de actinomicosis abdominal diagnosticada como consecuencia de la necesidad de terapéutica quirúrgica (hemicolectomía derecha en ambos casos). El examen histológico y de laboratorio que reveló la presencia de los característicos gránulos de azufre, confirmaron el diagnóstico. Se hacen consideraciones sobre localización forma de presentación, diagnóstico y tratamiento realziado. Antes de la era antibiótica, la actinomicosis producía una mortalidad del 80 al 85% de los caso; en la actualidad esas cifras han sido reducidas al 5% o menos. El antibiótico específico es la penicilina en altas dosis, por lapsos no menores a 1 año