Abdominal tuberculosis: varied presentations

ABSTRACT

To study various clinical presentations and out come of management of abdominal tuberculosis. Prospective cross-sectional study. This study was conducted at the Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur and Al-Khair Hospital Sukkur from January 2007 to December 2010. The 65 patients admitted throughout patient department and emergency with abdominal catastrophes. Ages ranged between 14 to 70 years. Out of 65 patients 37 were males and 28 were females. All the patients were evaluated with history, examination and investigations. 34 patients were operated and the resected tissue sent for histopathology to conform the diagnosis of tuberculosis. Out of 65 cases of abdominal tuberculosis, 37 were male and 28 female. The mean age was 30.9 years with SD 14.19 [range 14 to 70 years]. The mean duration of symptoms at presentation was 6 months [range 1 month to 24 months]. 35 [52.3%] out of 65 patients were admitted with different complications in which 10 [29.4%] presented with peritonitis due to gut perforation, 9 [26.5%] with sub-acute intestinal obstruction, 8 [23.5%] with abdominal mass, 5 [14.7%] with acute appendicitis and 2[5.9%] with umbilical fistula. Surgery was performed in all these patients, Stricturoplasty done in 13 [38.3%], Ileostomy in 8 [23.5%], resection anastomosis in 5[14.7%], Right Hemicolectomy in 5 [14.7%] and adhesionolysis and biopsy in 3 [8.8%] patients. Diagnosis in these patients was confirmed with biopsy. Morbidity and mortality in this group was 40.2% and 17.6% respectively. Early diagnosis of the abdominal tuberculosis is possible only by the specific investigations like PCR. As these are not available in the remote areas of Sindh so the general surgeons in the peripheral tertiary care hospitals have to face such patients with complications. Early diagnosis of ATB can be made by high index of clinical suspicion to symptoms of abdominal pain, weight loss, low grade fever and vague ill health of more than one month duration and refractory to conventional treatment associated with raised ESR, positive Montoux test. To above symptomatology if empirical ATT is started early many of the complications of ATB can be avoided