ABDOMINAL TUBERCULOSIS AN EXPERIENCE AT AYUB TEACHING HOSPITAL ABBOTTABAD

Ishtiaq Ali Khan, Irfan -ud-din Khattak, Saadia Asif, Mohammad Nasir, Zia -ur- Rehman

Abstract


Background: Abdominal tuberculosis is one of the common diseases in our country. This study was
performed at Surgical A Unit Ayub Teaching Hospital Abbottabad from August 2006 to December
2007 to asses the clinical presentation of abdominal tuberculosis and its management. Methods: All
patients presenting to outpatient department with clinical feature suggestive of abdominal
tuberculosis were included in the study. They were investigated. On the basis of clinical presentation,
patients were divided in two groups. Patients with acute abdomen (peritonitis, intestinal obstruction)
were prepared for laparotomy and operated upon. Required surgical procedure performed and tissue
diagnosis was obtained. Patients with sub-acute obstruction, chronic pain abdomen and mass
abdomen with out peritonism were managed conservatively. These patients were started on anti TB
drugs on the basis of clinical and laboratory assessment. Empiric therapeutic trial was conducted for
at least for 3 months with standard four drugs regimen. They were sent home on 9 month course of
Anti TB drugs and were advised to come for follow up twice a month. On reassessment good clinical
response was considered abdominal tuberculosis and anti TB continued with monthly follow up. In
case of no response patients were operated. Required surgical intervention performed and tissue was
taken to establish diagnosis. Detailed history, family history, examination findings, results of
investigations, operative findings of the histologically proven cases of abdominal tuberculosis were
recorded on a separate proforma and analyzed. Results: Amongst 76 patients majority were females
52 (68.4%). Most of the patients were young with mean age of 34 years. Abdominal pain was the
most common presentation 73 (96%) followed by fever and anorexia. Tender lower abdomen as
found in 53 (70%) patients and mass abdomen was found in 35 (46%). Family history of TB was
present in 20 (26%). Fifty three (70%) patients underwent laparotomy. Bands and adhesion was the
most frequent finding on laparotomy. Conclusion: Abdominal TB is more common in female and
abdominal pain fever and nausea are the most common presentations.
Keywords: Abdominal tuberculosis, abdominal mass, exploratory laparotomy

References


Butt T, Kazmi TB, Ahmad RN. Mehmood AA, Karamat K.A.

Anwar M. Frequency and antibiotic susceptibility pattern of

Mycobacterial Isolates from extra-pulmonary Tuberculosis

Cases. J Pak Med Assoc 2003;53:328–32.

Hossain J, Al-Aska, AK, Al-Mofleh I. Laparoscopy in

tuberculosis peritonitis, JH Soc med 1992;85(2):89–91.

Baloch AN, Baloch AM, Baloch AF. A study of 86 cases of

abdominal tuberculosis. J Surg Pak 2008;13(1):30–2.

Hameed F, Malik AM. Abdominal tuberculosis-Profile of 50

cases. J Coll Phys Surg Pak 2000;10:125–7

Maltezou HC, Spyridis P, Kafetzis DA. Extra-pulmonary

tuberculosis in children. Arch Dis Child 2000;83:342–6.

Fanning A. Tuberculosis: extra pulmonary disease. Can Med

Assoc J 1999;160:1597–603.

Baloch NA, Anees S ,Baber M, Maingal M .Abdominal

tuberculosis ,A review of 68 cases. J Surg Pak 2007;7:12–4

Bolukbas C, Bolukbas FF, Kendir T, Dalay RA, Akbayir N,

Sokmen MH, et al. Clinical presentation of abdominal

tuberculosis in HIV seronegative adults BMC Gastroenterol

;5:21.

J Ayub Med Coll Abbottabad 2008;20(4)

http://www.ayubmed.edu.pk/JAMC/PAST/20-4/Ishtiaq.pdf

Vogel Y, Bous JC, Winnekendonk G, Henning BF. Case report

tuberculous peritonitis in a German patient with primary biliary

cirrhosis: a case report. J Med Case Reports 2008;2:32.

Shehzad R, Osman L, Abid KJ, .Epidemiology, clinical

presentation and site of involvement in abdominal tuberculosis-a

retrospective study. Ann King Edward Med Coll 1999;5:228–9.

Al-quorian AA, Facharzt, Stti MB, Al-FreihiHMAl-GindanYM,

Al-Awad N. Abdominal tuberculosis in Saudi Arabia; A

clinicopathological study of 65 cases. Am J Gastroentrol

;88:75–9

Rai S, Thomas WM. Diagnosis of abdominal tuberculosis:the

importance of laparoscopy.J R Soc med 2003;96:586–8.

Tariq NA. Abdominal TB; The surgical audit of its presentation.

Pak J Surg1993;9(3):82–6.

Sinan T, Sheikh M , Ramadan S, Sahwney S and Behbehani

A. CT features in abdominal tuberculosis: 20 years experience.

BMC Medical Imaging 2002;2:3.

Griner MV, Skrynnik NA, Shteintsaig, Perforatsia Kishki pre

ee tuberkuleze (intestinal perforation in tuberculosis). Vestn Khir

Lm 11 Grek 1997;156(4):46–9.

Kakar A, Aranya RC, Nasir SK.Acute perforation of small

intestine due to tuberculosis. Aust N Z J Surg 1983;53:381–3.


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