Abdominal tuberculosis the surgical audit of its presentations

ABSTRACT

Two hundred and thirty cases of abdominal Tuberculosis were studied to evaluate the mode of presentation of the disease at surgical department of Nishtar Hospital, Multan. The main clinical features were pain abdomen, weight loss, fever with night sweats, vomiting, alternating diarrhoea and constipation and intestinal obstruction. Clinical diagnosis of the disease could be made in 72 patients. Twenty percent patients had mass in right iliac fossa and 28% had radiographic evidence of Intestinal obstruction. Laparotomy was performed in 170 cases and hislopathological examination of resected intestine or lymphnodes was undertaken to confirm the diagnosis. 142 cases were diagnosed at Laparotomy and 20 cases turned out as histopathological surprise. Ileocaecal tuberculosis was the commonest finding on laparotomy in 93 cases, 38 cases had miltiple ileal strictures and 32 patients had tuberculous peritonitis. Laparotomy is recommended as safe and effective procedure for diagnosing and managing tuberculous abdomen particularly when more sophisticated facilities are not available. The prominent features different from Western studies are 1. Tuberculosis is more prevalent in young females. 2. The intestinal tuberculosis is more common than peritonitis. 3. Due to late presentation major surgical procedures are more commonly performed. 4. A proportion of the patients responding to A.T.T gets fibrosing strictures and presents with acute intestinal obstructions