Experience With Abdominal tuberculosis

Abstract

Between March 1995 and June, 1997, 40 patients of abdominal tuberculosis were treated in the surgical A unit of PGMI Peshawar. Thirty (75%) patients were admitted through the casualtyas acute emergency, while the remainder presented as more insidious course and were admitted as elective cases. Mean age at time of presentation was 32.3 years. Male to female ratio was 1.1:1. Most of the patients bleonged to lower middle social class. Twenty two patients had intestinal tuberculosis while seventeen patients had tuberculous pertionitis. Common presenting features were pain (100%), Vomiting (72.5%), abdominal distension (50%) and pallor (55%). As most patents had to be operated in emergency, the only preoperative investigation done were X-ray which was negative in majority of the patients and ultrasonography which too gave nonspecific findings. Moderate anaemia, a raised ESR and leucocytosis in some cases were the common haematological findings. Coxisting pulmonary tuberculosis in some cases were the common haematological findings. Coexisting pulmonary tuberculosis was found in 12.5% cases. All the patients underwent surgery. Terminal ileum and ileo-caecal region were the common areas of involvement in the GIT, while peritoneum was the primary seat of involvement in 17 (42.5%) cases. Stricture formation was the most frequent pathology encountered. Perforation was seen in 5 (12.5%) cases, while an ileo -cecal mass was present in 5 (12.5%) cases. Diagnosis of abdominal tuberculosis was established histologically in all the 40 patients showing typical tuberculous granulomas with caseation in the involved tissues. Definitive surgical procedures was the mainstay of our treatment plan. Four severly ill patients died. In rest of the patients, recovery was well and all responded excellently to a standard regimen of anti tuberculous chemotherapy prescribed for at least 09 months.