Surgery for Abdominal Tuberculosis in the Present Era: Experience from a Tertiary Care Center.
BACKGROUND The role of surgery in abdominal tuberculosis is being redefined, as many patients will be candidates for endoscopic dilatation rather than open surgery. METHODS A retrospective analysis was done of the surgical procedures performed in patients with abdominal tuberculosis in a large tertiary care center in North India. Details such as clinical presentations, previous history of tuberculosis, any anti tubercular therapy (ATT) Mantoux skin test results, and the surgical procedures and findings were recorded. Short term outcomes also were analyzed. RESULTS Thirty five patients (26 male) were included, and the median age at presentation was 24 years (range 12 80 years) Sixteen patients had received prior ATT for abdominal tuberculosis. The indication for surgery was intestinal obstruction, perforation, and bleeding in 23 (66% 10 (29% and 2 (6% respectively. Twenty eight patients had intestinal strictures, with the ileum being the most common site (n 21) Perforation was present in 10 patients, of which six had multiple perforations. Cocoon abdomen was present in four patients, two of whom had associated small bowel stricture. Among 33 patients who underwent bowel resection, 14 had ileo cecal resection/right hemicolectomy. The rest had small bowel resection. Primary anastomosis and stoma creation was performed in 12 (36% and 21 (64% respectively. Post operative intra abdominal collections (p 0.02) and incision dehiscence (p 0.05) were more common in patients having stoma creation. CONCLUSION Surgical intervention is warranted in a subset of patients with abdominal tuberculosis and may be required in patients with recurrent intestinal obstruction or pain, intestinal perforation, or gastrointestinal bleeding.
Surgical infections