Koch's abdomen- management of surgical complications and outcomes at a remote hill area tertiary care center
Keywords:Koch’s abdomen, Tuberculosis, Laparotomy, Ileostomy
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.
Roy RN, Saha I. Tuberculosis. Respiratory Infections. Mahajan & Gupta Textbook of Prevent Social Medicine. 4ed. 2013: 193-207.
TB Facts. TB Statistics India – National. Available at: https://www.tbfacts.org/tb-statistics-india/. Accessed on 31 March 2019.
Singhal T, Lodha R, Kabra SK. Abdominal Tuberculosis. Paul VK, Bagga A. Ghai Essential Ped. 8 ed. 2013: 250-305.
Park K. TB: I-Respi Infections: Epidemiology of Communicable Dis. Park’s Tbk of PASM. 23 ed. 2015: 176-202.
Raviglione MC. Gastrointestinal TB. Tuberculosis. Harrison's Principles of Int Med. 19 ed. 2015: 1102-1122 (1111).
Tuberculosis in India. Available at: https://en.wikipedia.org/wiki/Tuberculosis_in_India. Accessed on 31 March 2019.
Tuberculosis Management: Drug Resistance. Available at: https://en.wikipedia.org/wiki/Tuber culosis_managementDrug-resistance. Accessed on 31 March 2019.
Rai DK, Bisht RS, Sikarwar V, Upadhyay SK. Clinicoepid. trend of TB in garhwal region. IOSR J Pharmacy. 2012;2(5):39-43.
Sanai FM, Bzeizi KI: Systematic review: TB peritonitis—presenting features, diag strategies & t/t. Aliment Pharmacol Ther. 2005;22:685–700.
Williams NS, O’Connell PR, McCaskie AW. B&L’s Short Practice of Surg. 27ed. 2018: 78-81.
Tuberculosis – India: Treatment of TB. Available at: https://www.tbcindia.gov.in/WriteReadData/l892s/8337437943TOG-Chapter%204-Treatment%20 of%20TB%20Part%201.pdf. Accessed on 31 March 2019.
Gohel J, Desai M, Sharma D, Patel N, Raswan U. Clinical profile of intraperitoneal TB. Int J Med Sci Public Health. 2016;5:559-62.
Agrwal P, Malpure S, Rajashankar S, Dhende N, Das S. Surgical treatment for abdominal tuberculosis: a review of fifty cases. Bombay Hosp J. 1999: 41.
Sharma MP, Bhatia V. Abdominal TB. Indian J Med Res. 2004;120:305-15.
Pathak P, Sahu SK, Agrawal S. Clinico-Pathological Profile and Surgical Outcome of Patients of Gastrointestinal Tuberculosis Undergoing Laparotomy. Chirurgia. 2016;111:487-92.
Charokar K, Garg N, Jain AK. Surgical management of abdominal tuberculosis: a retrospective study from Central India. Int Surg J. 2016;3(1):23-31.
Mishra AR, Thorat DD, Deshmukh VM. Prospective study of emergency presentation of Abd. TB. WIM J. 2016;3(1):19-27.
Arif M, Santosh V, Rajput AS. Cl. Profile &Surg Outcome Abd. TB–Retrospective Analysis. IntJ Med Health Sci. 2013;2(4):1.
Darbari A, Jauhari A, Darbari G, Shrivastava V, Shrivastava A. Abdominal tuberculosis: a study of 50 cases. Int J Res Med Sci. 2014;2(4):1453-61.
Pravin R, Pravir G. Abdominal TB. JAPI. 2016;64:38-47.
Chugh SN, Vinesh J. Abdominal TB — Current Concepts in Diag. &M/m. API India. 2007.
Bali RS, Jain R, Zahoor Y, Mittal A. Abdominal tuberculosis: a surgical emergency. Int J Res Med Sci. 2017;5(9):3847-50.
WHO. Index-TB Guidelines - Guidelines on extra-pulmonary tuberculosis for India. 2016: 63-66.
Chintamani. Ten Commandments of Safe and Optimum Abdominal Wall Closure. Ind J Surg. 2018;80:105.
Lahariya C. A brief history of vaccines &vaccination India. Ind J Med Res. 2014;139:491-511.
Erythrocyte Sedimentation Rate (ESR – Normal Values). Available at: https://en.wikipedia.org/wiki/ Erythrocyte_sedimentation_rateNormal_values. Accessed on 31 March 2019.
Tuberculosis – Pulmonary Manifestations. Available at: https://radiopaedia.org/articles/ tuberculosis-pulmonary-manifestations. Accessed on 31 March 2019.
Tuberculosis Radiology. Available at: https://en.wikipedia.org/wiki/Tuberculosis_radiology; Accessed on 31 March 2019.
Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, et al. Indian J Med Res. 2017;145:448-63.