Unusual presentations of abdominal tuberculosis.

OBJECTIVE: To review unusual presenting features and diagnostic difficulties of abdominal tuberculosis in an endemic region. DESIGN: Retrospective clinical study from 1984 to 1989, illustrated by case reports. SETTING: A single hospital in Kuwait. PATIENTS: Fifty patients with abdominal tuberculosis established by the standard histologic and bacteriologic demonstration of acid-fast bacilli or tuberculous granulomas. MAIN OUTCOME MEASURES: Site of disease and unusual features at presentation. RESULTS: Tubercular lesions are most commonly seen in the ileocecal region. They are also common in the ileum but are less common in the appendix and jejunum. Involvement of the ascending colon, rectum and upper gastrointestinal tract is rare. Abdominal tuberculosis presents in many ways depending on the degrees of ulceration, fibrous healing, infection and caseating abscess formation. CONCLUSIONS: Abdominal tuberculosis should be considered in immigrants from regions where this disease is endemic who present with abdominal signs and symptoms. Imaging studies, endoscopy and laparoscopy may preclude laparotomy for the diagnosis of abdominal tuberculosis. Antituberculosis chemotherapy is the mainstay of treatment.

Rational approach to therapy in splenic abscess.

Intrasplenic abscess is an uncommon but potentially lethal condition. Seven cases of splenic abscess were seen between 1985 and 1988. There are no specific clinical findings; symptoms and signs of fever, abdominal pain and tenderness were present in all seven cases but were only helpful in diagnosing splenic abscess in three cases. Computed tomographic scanning probably at present offers the most direct way of evaluating the spleen and making an early diagnosis. Splenectomy was done in three cases and antibiotics were used in four cases with equally successful results. Contrary to the prevalent opinion, we believe that medical management is an important addition to the surgeon's armamentarium and offers a viable alternative in selected cases of splenic abscess. A successful outcome is dependent on a high degree of clinical alertness, an aggressive diagnostic approach and prompt effective treatment.

Eosinophilic enteritis with perforation.

A case of eosinophilic granuloma of the gastrointestinal tract with free perforation is described. The authors believe this is the first such case to be published. The patient, a 60-year-old woman, had no history of allergy. At laparotomy, 100 ml of pus was aspirated. A 42-cm section of small bowel, containing multiple punched-out ulcers, was excised. The mucosa and submucosa of the operative specimen were edematous; there was a moderate inflammatory infiltrate containing numerous eosinophils and neutrophils. The lesion appeared to represent a local reaction to some antigen with resultant eosinophilic infiltration.

Roentgenographic cranial-base and calvarial measurements of north Indian children from birth to two years of age.

In order to establish norms for dimensions of the skull in North Indian children, lateral skull films of 166 apparently healthy, normocephalic children between birth and two years of age were studied. Using bony reference points, measurements were made of cranial-base length and calvarial height. It appears that there is definite proportionality between growth of ventral and posterior cranial-base, calvarium and ventral base, and anterior and posterior calvarium, at all ages and for both sexes. Deviation in these proportions may suggest abnormality in a corresponding area of the cranium.