Publication:

Surgical management of abdominal tuberculosis:a retrospective study from Central India

Background Abdominal tuberculosis is a diagnostic and therapeutic challenge in resource limited countries. The vague clinical presentation is a barrier to early diagnosis. The study aims to highlight the role of surgery in the diagnosis and treatment of abdominal tuberculosis.

Methods This is a descriptive study of abdominal tuberculosis cases, which were operated in the Department of Surgery, Peoples College of Medical Sciences & Research Centre, Bhopal from August 2010 to July 2015. Cases were analyzed in terms of demography, clinical features, investigations, operative treatment, and outcome.

Results 72 cases of abdominal tuberculosis were operated during the study period. The median age was 30 years with male to female ratio of 3:2. Primary abdominal tuberculosis was 79.2%. Intestinal tuberculosis was the commonest with terminal ileum and ileo-caecal region being predominantly involved. 58% of the patients required emergency surgery. Surgical procedures performed were: resection of the diseased segment including right hemi-colectomy 32 (44.44%), release of band/adhesions 23 (31.9%), perforation repair 11 (15.3%), stricturoplasty 4(5.5%), etc. In the presence of gross peritonitis, temporary ileostomy was performed. Complication and mortality rates were 33.3% and 2.6% respectively. No patient had post-operative intestinal-leak.The median duration of hospital stay was 14 days.

Conclusions Early diagnosis is the key factor in avoiding systemic and local complications of intestinal tuberculosis. In emergency cases, prompt surgical exploration and vigilant care is met with good recovery. Resection-anastomosis in the form of right hemi-colectomy or segmental resection has largely been adopted instead of simple bypass of obstructive lesions with good results.