Is abdominal tuberculosis a surgical problem?

INTRODUCTION: Abdominal tuberculosis (TB) has always been a diagnostic challenge, even for the astute surgeon. In developing countries, extrapulmonary TB often presents as an acute abdomen in surgical emergencies such as perforations and obstructions of the gut. Abdominal TB in different forms has been found more often as an aetiology for the chronic abdomen. This paper aims to evaluate TB as a surgical problem. METHODS: A comprehensive review of the literature on abdominal TB was undertaken. PubMed searches for articles listing abdominal TB/different types/diagnosis/treatment (1980-2012) were performed. RESULTS: TB is still a global health problem and the abdomen is one of the most common sites of extrapulmonary TB. Presentation may vary from an acute abdomen to a number of different chronic presentations, which can mimic other abdominal diseases. While some may benefit from antitubercular therapy, others may develop surgical problems such as strictures or obstruction, which may necessitate surgical intervention. CONCLUSIONS: Abdominal TB should always be considered one of the differential diagnoses of acute or chronic abdomen in endemic areas.

Diagnosis and management of schwannomas originating from the cervical vagus nerve.

INTRODUCTION: A schwannoma is a benign, slow growing, encapsulated nerve sheath tumour. Presentation of a schwannoma is a diagnostic and management challenge. METHODS: Internet searches of PubMed/MEDLINE(®) for all articles listing schwannomas of the vagus nerve in the cervical/neck region (1980-2012) were undertaken to ascertain diagnostic pitfalls. The references of all articles were cross-checked to include all pertinent contributions. Further articles were traced through reference lists. RESULTS: Schwannomas are solitary, well circumscribed and medial to the carotid sheath. Preoperative diagnoses of schwannomas in the lateral part of the neck can cause confusion with its nerve of origin (ie whether it arises from the vagus nerve or a sympathetic chain). Computed tomography and magnetic resonance imaging reveal valuable information regarding the location and origin of the tumour as well as aiding surgical planning. The diagnosis can be confirmed intraoperatively. Postoperative recovery of neurological function is dependent on the type of surgery. Histopathological studies searching for classical features and immunohistochemical staining for S100 also confirm the diagnosis. CONCLUSIONS: Schwannomas should be considered in the differential diagnoses of unusual masses in the neck. Preoperative imaging elicits valuable information regarding the location and origin of schwannomas and histopathology confirms the diagnosis.