Résumé
The aim of this study is to present our experience in the management of gastrointestinal tuberculosis in Iraq. 86 cases with intestinal tuberculosis were histologically proven by endoscopy or surgery, during the period 1965-2004 at the Medical City Teaching Hospital, and two private hospitals [Alousi and Mustansiria], Baghdad. 54[62.8%] were female and 32[37.2%] were male. Age ranged from 6-82 years [mean 33yrs], peak 30-39 years. Clinical presentation were; intestinal obstruction 44[51.2%], abdominal mass 20[23.3%], malabsorption 13[13%], massive gastrointestinal bleeding 3[3.5%], peritonitis 3[3.5%], pyloric obstruction 2[2.3%] and dysphagia 1[1.2%] patients. Chest X-ray reported; normal in 62[72.1%], active pulmonary tuberculosis in 3[3.5%], and healed lesion in 21[24.4%] patients. Barium study revealed dilated bowel loops in 31[45.6%]; other less frequent findings were strictures, filling defect, shortening and bowel irregularity. OGD showed a significant pathology in 7 out of 11 patients examined. Ultrasound showed helpful imaging modality in 15/21 patients; ascitis, masses, enlarged lymph nodes, and thick bowel loops in some cases. Site of lesions were; ileocecal 42[48.8%], small bowel 33[38.4%], colorectal 8[9.3%] and stomach 3[3.5%] patients. Gross appearance were hyperplastic 33[38.4%], ulcerative 20[13.9%], strictures 21[24.4], and mixed 12 [13.9%] patients. Surgical procedures were; right hemicolectomy 38[44.2%], resection of small bowel 23[26.7%], colectomy 4[4.7%], by-pass 4[4.7%], stricturoplasty 2[2.3%], and subtotal gastrectomy 1[1.2%] and biopsy only 14[16.3%] patients. One patient died post-operatively from pulmonary embolism, 6 lost to follow, 4 had relapse after stopped treatment within 3-5 months [one of them died from intestinal obstruction] while the result in those followed 74 [including 3 who relapsed and re-treated] patients whom received chemotherapy for over one year were very satisfactory. Gastrointestinal tuberculosis affects females more than males. No age is immune, peak in 3rd decade. Symptomatology is non-specific, it should be suspected in patients having abdominal pain, weight loss, anorexia, fever, ascites and abdominal mass. Sub-acute or acute intestinal obstruction is the most common presentation followed by abdominal mass or malabsorption in our study. Normal chest radiograph does not exclude the presence of abdominal tuberculosis, but it should be suspected in high ESR patients. Surgical interventions is not alternative to standard anti-tuberculous therapy
Résumé
The aim of this study is to compare the outcome of two sphincter-saving operations for ulcerative colitis namely total colectomy and ileorectal anastamosis [TC-1R] retrospectively with total procto-colectomy and ileo-anal [j] pouch anastamosis [TC-IA] prospectively. Surgery was indicated in 89[7.84%] among 1135 patients with ulcerative colitis of these; 57 subjected to TC-IR [Group A] during period 1968-1990 and 32 to TPC-IA [Group B] between 1991-2005, by Z R Al-Bahrani at the Medical City Teaching Hospital and Al-Mustansiria Private Hospital, Baghdad. Of these 89 patients, 41 were males and 48 were females. Mean [range] age in years was 35.5 +/- 13.3 [12-65]. Indications for surgery were; intractability 59[66.2%], carcinoma 13[14.6%], toxic colon 8[9%], sever bleeding 7[8%] and intestinal obstruction 2[2.2%] patients. The type of colitis were; pan-colitis 72[81%], left colitis 16[17.9%] and procto-sigmoiditis one [1.1%] patient. Pseudo-polyposis was seen in 52[58.5%] patients. The outcome of Group A [57 patients] were; post-operative mortality 2[3.5%], 1-3 complications minor and/or major in 31[53.4%] patients. After operation; normal defecation, bowel motion/day reduced from 8 to 5 [P<0.001], body weight/Kg increased from mean 53 to 62.5 [P<0.001] and the Hb gm/dl rose from mean 10.2 to 12.2 [P<0.001]. The outcome of Group B [32 patients]: post-operative mortality 1[3.1%], 1-3 complications minor and/or major in 16[50%] patients. After operation; control on defecation took few weeks-months to settle, bowel motion/day was reduced from a median 10 to 5 [P<0.001], body weight/kg increased from mean 52.9 to 56.2 [P=0.59[ns], and Hb gm/dl rose by a mean 03[P=0.68[ns]. Both surgical operations are super major and carry potential risk of complications and should be advised when medical treatment fails or serious complications of the disease arise which risk the patient's life or interfere with his normal life. Both procedures improve bowel motion, general health and quality of life without incontinence but total procto-colectomy and ileo-anal with pouch is considered superior to total colectomy and ileor-rectal anastomosis because excluding to a great extent the risk of rectal cancer