Publication:

Incisional hernia as a late surgical complication of an infertile patient treated for abdominal tuberculosis

Abdominal tuberculosis (TB) can be of various forms including peritoneal TB, tuberculous lymphadenopathy, gastrointestinal TB and visceral TB. The potential pathway includes direct spread to the peritoneum from infected adjacent foci, including the fallopian tubes or adnexa, or psoas abscess, secondary to tuberculous spondylitis. The exact stimulus for the inflammatory reaction is not known, but some suggest that it may arise due to a subclinical primary viral peritonitis, as an immunological reaction to gynaecological infections, or due to retrograde menstruation. The diagnosis of extra pulmonary TB can be difficult as it presents with nonspecific clinical and radiological features and requires high degree of suspicion for diagnosis. The abdominal TB, which is not so commonly seen as pulmonary TB, can be a source of significant morbidity and mortality and is usually diagnosed late due to its nonspecific clinical presentation. Approximately 15%-25% of cases with abdominal TB have concomitant pulmonary TB. Hence, it is quite important in identifying these lesions with high index of suspicion especially in endemic areas. Post – operative period in such patients is not smooth. They include prolonged hospital stay, enterocutaneous fistulae requiring re-operation upon failed conservative management, mortality associated with re-exploration, late complication being incisional hernia. Here we report a case of large incisional hernia following a laparotomy performed for non-resolving sub-acute intestinal obstruction which turned out to have tubercular origin later. The present case was managed by meshplasty using component separation technique (CST).