Acute Presentation and Management of Abdominal Tuberculosis.

OBJECTIVE: To study the clinicopatholgical profile and outcomes of surgical management of abdominal tuberculosis (ATB) Study Design: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Department of Surgery, Services Hospital, Lahore, Pakistan, from May 2008 to April 2018. METHODOLOGY: All patients who underwent emergency laparotomy during the study period due to abdominal tuberculosis, and consented to participate in the study were included. Demographic variables and type of surgical procedure performed were recorded. Patients were followed-up for histopathology, recurrence, or any anti-tuberculous therapy related complications at 1, 4, 6, and 12 months. Data were analysed using SPSS version 21. RESULTS: Out of the 80 patients, 36 were males and 44 were females. The median age was 23.5 years (range = 11-90 years). Mean weight of the patients was 48.7 ±12.2 kg. Commonest presenting symptom was abdominal pain 72 (90%). On exploration, ileocecal region was most commonly involved segment 68 (85%). Stoma formation was the most common surgical procedure performed in 59 (73.8%) patients. Complications and mortality rate were 48 (60%) and 7 (8.7%), respectively. A significant relationship of complications was found with prolonged hospital stay (p <0.001). CONCLUSION: Abdominal tuberculosis is a major public health concern. Vague symptoms lead to diagnostic delay so patients present late with intestinal obstruction. Ileocecal tuberculosis is the most common site of involvement.

Stone in the distal jejunum presenting as small bowel obstruction: A case report.

INTRODUCTION: Gallstone ileus is a rare presentation of cholelithiasis accounting for around 4% of cases of small bowel obstruction under 65 years of age but rises to 25% in those more than 65 years of age. Most gall stones, if impact in the bowel, are seen to lodge at the ileocecal valve as this is the most narrow part of the bowel. PRESENTATION OF CASE: We present a case of small intestinal obstruction because of a gallstone stuck in the distal jejunum. Patient was explored and one-stage surgery was done i.e. cholecystectomy, enterotomy and stone retrieval, and fistula repair. Our patient had uneventful postoperative recovery and was discharged after a week. DISCUSSION: Gallstone ileus is a rare entity presenting a significant diagnostic challenge to surgeons due to lack of specific findings. Moreover, the surgical management options to be adopted are diverse and depend upon the condition of the patient. Stable patients can be managed with two-stage procedures i.e. enterotomy and stone retrieval earlier with cholecystectomy in an elective setting. Our patient was managed with one-stage procedure i.e. cholecystectomy was done in the same setting and our patient did well. CONCLUSION: Gallstone ileus needs to be kept in the differential diagnosis list of intestinal obstruction in middle aged patients even in the absence of history of gallstones as this may be the first presentation of gallstone disease.