Koch's abdomen- management of surgical complications and outcomes at a remote hill area tertiary care center

Amit Keshri; Anil Kumar; Sanjeev Prakash; Khem Pal Singh

doi:10.18203/2349-2902.isj20191613

Authors

Amit Keshri Department of Surgery, Veer Chandra Singh Garhwali Government Medical Sciences & Research Institute, Srinagar, Uttarakhand, India
Anil Kumar Department of Surgery, SHKM Govt. Medical College, Nalhar, Nuh, Haryana, India
Sanjeev Prakash Department of Surgery, Veer Chandra Singh Garhwali Government Medical Sciences & Research Institute, Srinagar, Uttarakhand, India
Khem Pal Singh Department of Surgery, Veer Chandra Singh Garhwali Government Medical Sciences & Research Institute, Srinagar, Uttarakhand, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191613

Keywords:

Koch’s abdomen, Tuberculosis, Laparotomy, Ileostomy

Abstract

Background: Abdominal tuberculosis needs surgical intervention in a subset of patients; both in emergency and elective settings, requiring surgeons to be familiar with its varied and non-specific modes of presentation and their diagnosis and management.

Methods: Patients of abdominal tuberculosis, having undergone surgical management at our Institute, VCSGGMS&RI-UT, between April 2015 to March 2019, numbering eighty (n= 80), were included in this concurrent observational study.

Results: Middle age-group patients (20-50 years; 56.3%) with a male majority (73.8%) predominated. Reinfection/ relapse of tuberculosis infection might occur despite BCG immunisation (46.3%) and course of ATT (16.3%); complications like bowel obstruction (28; 35%), perforation etc. need laparotomy to effect relief, with stomy formation required (51.3%) frequently; inadequate recovery warranting a secondary/re-look laparotomy (15; 18.8%). Prolene suture for abdominal wound closure is advantageous with a lesser rate of complications and incisional hernia. Septicemia, multi-organ dysfunction, wound infection should be aggressively managed to prevent adverse outcomes, including death (10; 12.5%).

Conclusions: Adequate, intensive and timely surgical intervention/laparotomy, with nutritional support, stomy care and concurrent ATT can result in prompt relief and speedy recovery of patients with abdominal tuberculosis.

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