A retrospective cohort study of 756 cases of abdominal tuberculosis: Two decades single centre experience.

AIM/OBJECTIVE: India accounts for the highest tuberculosis burden in the world, and abdominal tuberculosis has been an endemic surgical and gastroenterological problem. Aim of this study is to present our two decades experience on abdominal (gastrointestinal) tuberculosis. METHOD: 756 patients, who received standard antituberculous treatment with or without surgical treatment with the diagnosis of abdominal tuberculosis from January 1996 and May 2014, were reviewed retrospectively. On the basis of clinical presentation, four groups of clinical presentation were identified and various diagnostic measures used in different groups were studied. Numeric values were determined as percent or mean±standard deviation. Kruskal-Wallis test was used for quantitative results and chi-square test was used for qualitative results between groups. p value of less than 0.05 was considered to indicate the statistical significance. RESULTS: The duration of symptoms was variable in this study. Out of 756 patients, 64 patients gave definite past history of tuberculosis. Most of the patients in the acute pain abdomen group required surgery while most patients in chronic pain group responded well to medical management. There was significant difference in mortality among the four groups (p=0.025). CONCLUSION: Prognosis seems significantly related to the severity of disease, with graver prognosis and less symptomatic improvement in more seriously ill presentations.

Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis.

BACKGROUND: To determine the indications, nature, and rate of early complications of temporary loop ileostomy created in emergency for benign diseases, their management, and to find out the associated risk factors. METHODS: A total of 630 patients undergoing temporary loop ileostomy for benign diseases were studied prospectively over a period of 6 years. Stoma-related early complications occurring within 6-8 weeks were analyzed. Only emergency cases were included in this study. Descriptive statistics were used to summarize the data and statistical significance was evaluated by applying the Pearson's chi-square test. RESULTS: Typhoid perforation (n=402) was the most commonpathology, followed by tuberculosis (n=106); trauma (n=81); and intestinal obstruction with gangrenous bowel (n=41). 299 patients had no stoma-related complications. Skin excoriation was the most commonstoma-related complication. Age more than 50 years; shock at presentation; delay in presentation; delay in surgery; presence of comorbidities; and surgery done out of working hours, were associated with increased complications. CONCLUSION: Temporary loop ileostomy for perforation peritonitis due to benign systemic diseases like typhoid fever and tuberculosis confers a very high morbidity.

Periappendicitis: our 13 year experience.

INTRODUCTION: Periappendicitis is defined as appendiceal serosal inflammation without mucosal involvement. It is a rare benign pathology, diagnosis is difficult and carries high morbidity. A detailed literature and large series are still lacking on periappendicitis. Aim of this study is to present our clinical experience with periappendicitis. METHODS: 36 of retrospectively reviewed 1232 acute appendicitis patients were found to have periappendicitis on histopathological examination. Histopathological finding of appendicitis with periappendicitis in emergency appendectomy, and cases of interval appendectomy were excluded. Descriptive statistics were used to summarize the data. RESULTS: The most common diagnosis was salpingitis (12), followed by pelvic inflammatory disease (9), typhoid enteritis (5), peritoneal tuberculosis (3), inflammatory bowel disease (3), and amoebiasis (1), while 3 cases remained undiagnosed. DISCUSSION: Periappendicitis is due to extra-appendicular pathologies resulting in serosal inflammation of the appendix without mucosal involvement. In the absence of any significant history, it is difficult to distinguish periappendicitis from the common entity of acute appendicitis only on the basis of clinical examination and laboratory parameters. CONCLUSION: Pre-operatively, it is difficult to diagnose periappendicitis, but it should be considered if the clinical signs and imaging findings are suggestive of any associated pathology in addition to the presence of typical picture of acute appendicitis and post-operatively if the patient develops any new clinical signs, as this can cause morbidity to a significant level.