Clinical Presentation and Surgical Management of Intestinal Tuberculosis Presented as an Acute Abdomen

Abstract

Objective: To review the various clinical presentations and different surgical options in the management of intestinal tuberculosis at a tertiary care hospital.

Methodology: This two-year descriptive cross-sectional study was conducted at LUMHS; using a convenient sampling technique, all patients aged between 18-60 years of either gender presented with acute or sub-acute intestinal obstruction or peritonitis were admitted. Detailed history, thorough clinical examination, and relevant investigations were performed. Only those patients in whom, per operative findings of intestinal tuberculosis and later on confirmed histopathology were included in this study. Data was analyzed on SPSS version 22, and results were analyzed for mean, frequency, and percentage.

Results: A total of 47 patients with intestinal tuberculosis were included. The mean age was 27.01±4.88 years, and the male to female ratio was 1.6:1. The most common constitutional symptom was weight loss in 85.1%patients, followed by fever 51% and anorexia 57.4%. Common abdominal symptoms were pain 93.6%, distension 72.34%, nausea and vomiting in 55.31%, and alternating bowel habits in 42.55% cases. 61.7% of patients presented with signs of acute or sub-acute intestinal obstruction followed by peritonitis in 21.2% and abdominal mass in 17% of patients. Ileostomy was the lifesaving procedure performed in 40.4% of cases. Other procedures were adhesiolysis, stricturoplasty, limited right hemicolectomy, segmental small bowel resection, and end-to-end anastomosis.

Conclusion: Intestinal tuberculosis is still an endemic disease in low-resource countries. Clinical presentation mimics many other abdominal conditions results in a delay in diagnosis. Differential diagnosis should always be kept in mind to diagnose this contagious disease.

KEY WORDS: Intestinal tuberculosis, Constitutional symptoms, Intestinal obstruction, Ileostomy