SRICTUROPLASTY IN TUBERCULOUS SMALL BOWEL STRICTURES
AbstractBackground: This study was conducted at DHQ Hospital Hangu, Babul Madina Medical Centre & Shifa Medical Centre Hangu from March 1995 to February 2001 to evaluate the presentation of tuberculous small bowel strictures and assess the usefulness and applicability of stricturoplasty to these lesions. Methods: Ten patients were included in the study in whom the diagnosis of tuberculous small bowel strictures was made on laparotomy and histopathological examination of the tissues taken from the strictures. Heinki/Mikulikz's type stricturoplasty was done in all the cases. The patients were kept on antitubercular drugs and were followed for assessment of outcome. Results: Seventy percent of the patients’ presented/ operated upon in emergency. Age ranged from twenty to forty years with mean age 31.5 years. Male to female ratio was 6:4. Weight loss and malnutrition were the most common associated features. Terminal ileum alone was involved in 50% of the cases. The strictures were solitary in six and multiple in four cases. The lesions were acute in four and chronic in six patients. Stricturoplasty worked well both in acute and chronic cases. Conclusion: Stricturoplasty is safe, simple, and easy procedure particularly suitable at poorly equipped and under staffed district hospitals.Keywords: Intestinal tuberculosis, Strictures, stricturoplasty.
Abrams JS, Holden WD. Tuberculosis of the Gastrointestinal tract. Arch Surg 1964;89:282-93.
Bhansali SK. The challenge of abdominal tuberculosis in 310 cases. Ind J Surg 1978;40:65-77.
Bhansali SK. Abdominal tuberculosis: Experience with 300 cases. Am.J Gastroenterol 1977;67:324-37
Pimparker BD. Abdominal tuberculosis. J Assoc Phys India 1977;25:801-11.
Khan C. Abdominal tuberculosis and it's surgical managment. Pakistan J Gastroenterol 1989;3(1):22-5
Pujari BD. Modified surgical procedures in intestinal tuberculosis. Br J Surg 1989;66:180-4.
Kum CK, Sim EK, Nooi SS, Goh P, Sinniah R. The surgical treatment of multiple small bowel strictures in Crohn’s disease by combined resection and stricturoplasty. Med J Malaysia 1992;47(4):323-7.
Hurst RD, Michlssi F. Stricturoplasty for Crohn’s disease: Techniques and long term results. World J Surg 1998;22:359-63.
Thomson-JS. Reoperation in patients with short bowel syndrome. Am J Surg 1992;164(5):453-6.
Matsuhashi N, Yamada A, Hiraishi M, Konishi J, Minota S, Saito T, et al. Multiple strictures of the small intestine after long term non steroidal anti inflammatory drug therapy. Am J Gastroentrol 1992;87(9):1183-6
Kuwajerwla NK, Bapat RD, Joshi AS. Mesenteric vasculopathy in Intestinal tuberculosis Indian. J Gastroenterol 1997;16(4):134-6
Dandapat MC, Mahapatra SK, Nanda N. Conservative surgical management of intestinal tuberculosis J Indian Med Assoc 1990;88:156-8.
Katariya RN, Sood S, Rao PG. Strituroplasty for Tubercular strictures of the gastrointestinal tract. Br J Surg 1977;64:494-6.
Cuschieri A, Steele RJC, Moosa AR. Disorders of Stomach & Duodenum. In Essential Surgical Practice fourth edition. ARNOLD-2000, Module 8 Page 294.
Mohayuddin QK. Intestinal tuberculosis. Proceedings of 12th Pakistan tuberculosis seminar 29th Nov–1st Dec 1974: NWFP Tuberculosis Association. 52.
Bufo AJ, Feldman S, Daniels GA, Lieberman RC. Stapled stricturoplasty for Crohn's desease. A new technique Dis Colon Rectum 1995;38:664-7.
Ball WS, Kosloske AM, Jewell PF, Seigel RS, Bartow SA. Balloon catheter dialitation of focal intestinal strictures following nacrotizing enterocolitis. J Pediatr Surg 1985;20:637-9.
Fragunese D, Di Falco G, Di Toma F. Balloon dilatation of inanastomotic intestinal stenosis, long term results. Endoscopy 1990;22:249-53.
Williams AJ, Palmer AR. Endoscopic balloon dilatation as a therapeutic option in the management of Intestinal strictures resulting from Crohn’s disease. Br J Surg 1991;78:453-4.
Anand SS, Pathak IC. Surgical treatement of abdominal tuberculosis with special reference to ileocecal tuberculosis. Ind J Med Assoc 1961;37(9):423-9.
Ohri BB, Agrawal VK. Treatment of Intestinal tuberculosis J Ind Med Assoc 1964;43(3):120-4.
Das P, Shukla HS. Clinical diagonoses of intestinal tuberculoses. Br J Surg 1976;63:941-6.
Kristen D, Polke-K, Kroeger-C, Magnussen H. Memento intestinal tuberculosis. Med Klin 1992;87(11):580-3.
Bilbao GJ, Deletona JM, Carreno MC, Perez MR. Abdominal tuberculosis today. A review of 46 cases. Rev-Clin-Esp 1992;191(1):19-24.
Anand SS. Hypertrophic ileocaecal tuberclusis in India with a record of 50 hemicolectomies. Ann. R Coll Surg England 1956;19:205-21.
Palmer KR, Patil DH, Basran GS, Riodan JF. Abdominal tuberculosis in urban Britian—a common disease. Gut 1985;26:1296-305. .
Levis EA, Kolawole TM. Tuberculous ileocolitis in Ibadan. A clinicoradiological review. Gut 1972;13:646-53.
Levis EA, Aboyo AA. Tuberculosis of abdomen in Ibadan. Aclinicopathalogical review. Tubercle 1975;56:149-55.
Parkash TM. Intestinal tuberculosis—18 years review. Ind J Surg 1978;40:56-64.
Mukarjee P, Singal AK. Intestinal tuberculosis 500 operated cases. Proc Assoc Surg East Africa 1979;2:70-5.
Bjorneklett A, Hoverstad T, Hoving T. Bacterial overgrowth. Scand J Gastroenterol 1985;109:123-32.
Underwood MJ, Thompson MM, Sayers RD, Hall AW. Presentation of Abdominal tuberculosis to general Surgeons. Br J Surg 1992;79(10):1077-9.