SPECTRUM OF CLINICAL PRESENTATION AND SURGICAL MANAGEMENT OF INTESTINAL TUBERCULOSIS AT TERTIARY CARE HOSPITAL
AbstractBackground: Tuberculosis can involve gastrointestinal tract anywhere from mouth to anus, theperitoneum and pancreatobiliary system. It has varied clinical presentations sometimes mimicking othercommon abdominal diseases. Tuberculosis continues to be a major problem especially in developingcountries, being responsible for 7–10 million new cases and 6 per cent of deaths worldwide annually.Objective was to assess and evaluate various clinical presentations and management of intestinaltuberculosis at Liaquat University Hospital, Jamshoro/Hyderabad. Methods: This 3-year descriptivestudy was conducted on patients with diagnosed intestinal tuberculosis (by histopathology) in SurgicalUnit-I, from January 2006 to December 2008. Detailed history and clinical examination was performedin all the cases. Investigations like Blood CP and ESR, Urea, RBS Electrolytes, Serum A/G Ratio,Ultrasound abdomen, X-Ray chest and abdomen were carried out in all the cases while barium meal,follow through and CT Scan abdomen were performed in selected cases. Preoperative assessment ofanatomical site and variety of lesions were also noted. Results: A total of 60 patients with diagnosis ofintestinal tuberculosis were admitted and operated. Diagnosis was confirmed by histopathology.Among these, 28 (46.7%) were male, and 32 (54.1%) were female. Variable clinical presentations wereseen. Majority of patients (46, 76.7%) had abdominal pain, 26 (43.3%) had vomiting; abdominaldistension was seen in 22 (36.7%) cases, diarrhoea and constipation in 16 patients (26.7%) andabdominal mass in 14 patients (23.3%). Majority of patients had ulcerostenotic type of tuberculosis.Single stricture of ileum was seen in 15 (25%) while multiple strictures were seen in 13 (21.7%). Ilealperforation was seen in 6 (10%) patients. Weight loss was seen in 40 (66.7%) patients, fever 36 (60%),night sweats 30 (50%), anorexia in 30 (50%) and pulmonary tuberculosis in 18 (30%) patients.Resection and anastomosis was performed on 24 (40%) cases, right hemicolectomy on 22 (36.7%),stricturoplasty on 8 (13.3%), adhesionolysis on 4 (6.7%), and Ileostomy on 2 (3.3%) patients.Conclusion: Abdominal pain, vomiting, fever and weight loss are the commonest symptoms inabdominal tuberculosis. Single and multiple strictures in the ileum, and mass in the ileocaecal regionwere the commonest lesions. Definitive surgical procedure like resection and anastomosis,stricturoplasty and right hemicolectomy are the main surgical options.Keywords: Intestinal tuberculosis, tuberculosis, abdominal tuberculosis, TB, stricture, perforation
Sharma D, Gupta A, Jain BK Agrawal V, Dargan P, Upreti L, et
al. Tuberculous gastric perforation: report of a case. Surg Today
Ahmed A, Pereira SP, Steger A, Starke I. Abdominal
tuberculosis: the great mimic. Hosp Med 2001;62:368–9.
Kishore PV, Chandresekher TS, Palaian S. Diagnosing
abdominal tuberculosis. Retrospective study. Internet J
Gastroenterol 2008;6(2). URL: http://www.ispub.com/oscia/
J Ayub Med Coll Abbottabad 2010;22(3)
Sheer TA, Coyle WJ. Gastrointestinal tuberculosis. Curr
Gastroenterol Rep 2003;5:273–8.
Rangabasym N, Anand BS, OmPrakash R. Abdominal
tuberculosis. In: Oxford Textbook of Surgery, Vol. 3, 2nd ed.
Oxford: Oxford University Press; 2000.p. 3227–9.
Safarpor F, Aghajanzade M, Kohsari MR, Hoda S, Sarshad A,
Safarpor D. Role of laparoscopy in the diagnosis of abdominal
tuberculosis. Saudi J Gastroentrol 2007;13(3):133–5.
Muneef MA, Memish Z, Mahmoud SA, Sadoon SA, Bannatyne
R, Khan Y. Tuberculosis in the belly; a review of forty-six cases
involving the gastrointestinal tract and peritoneum. Scand J
Uygur-Bayramiçli O, Dabak G, Dabak R. A clinical dilemma;
abdominal tuberculosis. World J Gastroenterol 2003;9:1098–1101.
Ismail Y, Muhamad A. Protean manifestations of gastrointestinal
tuberculosis Med J Malaysia 2003;58:345–9.
Afshan Z, Abrar M, Qureshi MI. Comparison between stricture
plasty and resection anastomosis in tuberculous intestinal
strictures. J Coll Physicians Surg Pak 2003;5:277–9.
Kapoor VK, Sharma LK. Abdominal tuberculosis. Br J Surg
Naz F, Chaudhry ZA, Haq A, Ahad A, Chaudhry ZA, Waseem
A. abdominal tuberculosis: a review of 25 cases. Ann King
Edward Med Coll 1999;5(2);180–3.
Niaz K, Ashraf M. Intestinal tuberculosis: Diagnostic dilemma.
Professional Med J 2010;17:532–7.
Joy B, Gulshan B, Michael KC. Gastrointestinal tuberculosis: an
eighteen patient experience and review. J Clin Gastroenterol
Pettengell KE, Larsen C, Garb M, Mayet FG, Simjee AE, Pirie
D. Gastroinestinal tuberculosis in patients with pulmonary
tuberculosis. Q J Med 1990;74(275):303–8.
Sircar S, Tanija VA, Kansra V. Epidemiology and clinical
presentation of abdominal tuberculosis. A retrospective study. J
Indian Med Assoc 1996;94:342–4.
Abro H, Shah A, Mohammad W. Ultrasound findings in
abdominal tuberculosis. Med Channel 2004;10(2):32–4.
Akhan O, Pringot J. Imaging in abdominal tuberculosis. Eur
Batra A, Gulati MS, Sharma D, Paul SB. Sonographic
appearance in abdominal tuberculosis. J Clin Ultrasound
Malik A, Saxena NC. Ultrasound in abdominal tuberculosis.
Abdom Imaging 2003;28:574–9.
Hassan I, Brilakis ES, Thompson RL, Que FG. Surgical
management of abdominal tuberculosis. J Gastrointest Surg
Ibrarullah M, Mohan A, Sarkari A, Srinivas M, Mishra A,
Sundar TS. Abdominal tuberculosis: diagnosis by laparoscopy
and colonoscopy. Trop Gasteroenterol 2002; 23:150–3.
Bhargava DK, Gupta M, Nijhawan S, Dasarathy S, Kushwaha
AK. Adenosine deaminase (ADA) in peritoneal tuberculosis:
diagnostic value in ascitic fluid and serum. Tubercle
Gan HT, Chen YQ, Quyang Q, Bu H, Yang XY. Differentiation
between intestinal tuberculosis and Crohn’s disease in
endoscopic biopsy specimens by polymerase chain reaction. Am
J Gastroenterol 2002;97:1446–51.
Vaidya MC, Sodhi JS. Gastrointestinal tract tuberculosis: a study
of 102 cases including 55 heicolectomies. Clin Radioil
Chumber S, Samaiya A, Subramaniam R et al. Laparoscopy
assisted hemo-colectomy for ileo-caecal tuberculosis. Trop
Negi S, Sachdev AK, Choudhary A, Kumar N, Ranjana.
Surgical management of obstructive gastroduodenal tuberculosis.
Trop Gastroenterol 2003;24:39–41.
Akbar M. Stricturoplasty in tuberculous small bowel strictures J
Ayub Med Coll Abottabad 2003;15(2):37–40.
Talwar S, Talwar R, Prasad R. Tuberculous perforations of the
small intestine. Int J Clin Pract 1999;53:514–8.
Rajput MJ, Memon AS, Rani S, Hamad A. Clinipathological
profile and surgical management outcomes in patients
suffering from intestinal tuberculosis. J Liaqual Uni Med Health
Marshal JB. Tuberculosis of gastrointestinal tract and
peritoneum. Am J Gastroenterol 1993;88:989–99.