DOI: http://dx.doi.org/10.18203/2349-2902.isj20201167

A clinical study of various presentations of intestinal tuberculosis, evaluation, management and its complications

Maruti Basa, Karnati Prakash

Abstract


Background: Abdominal tuberculosis includes tuberculous infection of gastrointestinal tract, mesentery, lymph nodes and omentum, peritoneum and solid organs like liver and spleen. The initial clinical presentations are nonspecific and no single laboratory investigation is pathognomonic. Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests though rewarding is expensive. Moreover, abdominal tuberculosis with an acute abdomen presents as an enormous challenge to the surgeon.

Methods: This one-year prospective observational study of 25 patients who presented with intestinal tuberculosis at the Department of General Surgery, NIMRA Medical College from February 2019 to January 2020. The causes of intestinal tuberculosis were determined along with clinical profile and were monitored for outcome based on the morbidity and mortality.

Results: Among the 25 patients, all had intestinal tuberculosis on the basis of operative findings and histopatholoigcal reports. Age of the patients ranged between 9 to 70 years; majority (75%) were in the age group of 20 to 40 years. Female to male ratio was 1.7:1. The commonest operative findings were hyperplastic ileocaecal tuberculosis (16%), followed by strictures (20%), and perforations (24%). The overall mortality was 8% due to sepsis and septic shock.

Conclusions: Intestinal tuberculosis is a common problem presenting to general surgical units in the developing countries, often in an acute form. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis, in order to minimize complications.


Keywords


Intestinal tuberculosis, Acute abdomen, Intestinal obstruction, Peritonitis, Koch’s abdomen

Full Text:

PDF

References


Lonnroth K, Raviglion M. Global epidemiology of tuberculosis: Prospects for control. Semin Respir Crit Care Med. 2008;29:481.

Dolin PJ, Raviglione MC, Kochi A. Global tuberculosis incidence and mortality during 1990-2000. Bull World Health Organ. 1994;72:213-20.

Tan KK, Chen K, Sim R. The spectrum of abdominal tuberculosis in a developed country: a single institution’s experience over 7 years. J Gastrointest Surg. 2009;13:142-7.

Gondal KM, Khan AFA. Changing pattern of Abdominal Tuberculosis. Pak J Surg. 1995;11:109-13.

Singh V, Jain AK, Agarwal AK, Gupta S, Khanna S, Khanna AK, et al. Clinicopathological profile of Abdominal tuberculosis Br J Clin Pract. 1995;49:22-4.

Ranitya R, Syam AF, Kolopaking MS, Yuwono V. Diagnostic Problem and Management of Intestinal Tuberculosis. Indonesian J Gastroenterol Hepatol Digestive Endoscopy. 2001;2(3):25-7.

Kapoor VK. Abdominal tuberculosis. Postgrad Med J. 1998;74:459-67.

Marshal JB, Paustian FF. Intestinal tuberculosis. In: Berk JE, Roth JL, Haubrich WS, Shaffner F, et al. (eds). Bockus Gastro-enterology, 4th ed; Philladelphia: WB Saunders Company; 1985: 2018-2035.

Singhal A, Gulati A, Frizell R, Manning AP. Abdominal tuberculosis in Bradford, UK: 1992-2002. Eur J Gastroenterol Hepatol. 2005;17:967-71.

Prout WG. Multiple tuberculous perforations of ileum. Gut. 1968;9:381-2.

Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F. Intestinal tuberculosis mimicking Crohn's disease: lessons relearned in a new era. Eur J Gastroenterol Hepatol. 2007;19:347-9.

Chu CM, Lin SM, Peng SM, Wu CS, Liaw YF. The role of laparoscopy in the evaluation of ascites of unknown origin. Gastrointest Endosc. 1994;40:285-9.

Lin CJ, Wu CS, Chen PC, Kuo YC, Chang KY, Wu SS, et al. Endoscopic diagnosis and clinical experience of colonic tuberculosis. Chang Gung Med J. 1996;19:298-304.

Wells AD, Northover JMA, Howard ER. Abdominal tuberculosis. Still aproblem today. J R Soc Med. 1986;79:149-53.

Chang HT, Leu S, Hsu H, Lui WY. Abdominal tuberculosis--a retrospective analysis of 121 cases. Zhonghua Yi Xue Za Zhi (Taipei). 1991;47:24-30.

Chen YM, Lee PY, Perng RP. Abdominal tuberculosis in Taiwan: a report from Veterans’ General Hospital, Taipei. Tuber Lung Dis. 1995;76:35-8.