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Ghabisha S, Ahmed F, Almohtadi AM, Alghazali KA, Badheeb M, Al-Wageeh S. Demographic, Clinical, Radiological, and Surgical Outcome of Patients with Intestinal Tuberculosis: A Single-Center Retrospective Study. Res Rep Trop Med 2024; 15:79-90. [PMID: 39253062 PMCID: PMC11382657 DOI: 10.2147/rrtm.s465571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/31/2024] [Indexed: 09/11/2024] Open
Abstract
Background Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome. Methods This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed. Results 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%). Conclusion Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up.
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Affiliation(s)
- Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
| | - Abdullatif Mothanna Almohtadi
- Department of Radiology, School of Medicine, Ibb University, Ibb, Yemen
- Department of Radiology, Ibb Scan Center, Ibb, Yemen
| | - Khairalah Abdulkarem Alghazali
- Department of Radiology, Ibb Scan Center, Ibb, Yemen
- Department of Medical Immunology and Microbiology, School of Medicine, Jiblah University for Medical and Health Sciences, Ibb, Yemen
| | - Mohamed Badheeb
- Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USA
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen
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Ayoub M, Ouazni M, Achraf M, Sanae A, Mehdi S. Surgical management of sclerosing encapsulating peritonitis (SEP) secondary to tuberculosis: A case report and review of the literature. Int J Surg Case Rep 2024; 115:109292. [PMID: 38271865 PMCID: PMC10818070 DOI: 10.1016/j.ijscr.2024.109292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP), commonly known as abdominal cocoon syndrome (ACS), is considered one of the rare causes of bowel obstruction [1]. CASE PRESENTATION In this article, we report the case of a 20-year-old male patient with a 6-month history of recurrent colicky right-sided upper abdominal pain accompanied by nausea, vomiting and bloating, which gradually increased in severity and frequency. The contrast-enhanced abdominal computed tomography suggested a small bowel obstruction with a differential diagnosis of SEP. Later exploratory laparotomy and histopathological examination confirmed the diagnosis of ACS. Intraoperative adhesiolysis was performed and the patient's symptoms resolved. DISCUSSION This syndrome is characterised by the formation of a fibrous-collagenous membrane that partially or completely engulfs the small intestine, less commonly the colon and other abdominal organs. SEP is most commonly associated with long-term peritoneal dialysis, although drugs, peritoneal infection and systemic inflammatory disorders have been implicated. Patients often present with symptoms of partial bowel obstruction, which is difficult to diagnose before laparotomy. Of the available investigations, contrast-enhanced CT of the abdomen is the most sensitive, showing a fibrous sac-like membrane covering the intestinal loops and the fluid collection. Definitive treatment includes excision and adhesiolysis. CONCLUSION This article presents a rare case and focuses on the management of this pathology with a review of the literature.
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Affiliation(s)
- Madani Ayoub
- Department of General Surgery, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco.
| | - Mohammed Ouazni
- Department of General Surgery, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| | - Miry Achraf
- Department of Anatomopathology, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| | - Abbaoui Sanae
- Department of Anatomopathology, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| | - Soufi Mehdi
- Department of General Surgery, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
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Tahiri M, Goh KL, Abbas Z, Epstein D, Min-Hu C, Mulder CJJ, Puri AS, Schultz M, LeMair A, Melberg J. Digestive Tract Tuberculosis Guideline. J Clin Gastroenterol 2023; 57:643-650. [PMID: 37428083 DOI: 10.1097/mcg.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/21/2022] [Indexed: 07/11/2023]
Affiliation(s)
| | - Khean-Lee Goh
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Zaigham Abbas
- Ziauddin University Hospital Clifton, Karachi, Pakistan
| | | | - Chen Min-Hu
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | | | | | - Michael Schultz
- University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
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Sahibole AS, Farooq R, Ali HM, Bukhari SJ, Al Ozaibi LS. Abdominal Tuberculosis Presenting With Small Bowel Obstruction: A Case Report. Cureus 2023; 15:e37459. [PMID: 37187622 PMCID: PMC10181890 DOI: 10.7759/cureus.37459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Abdominal tuberculosis (TB) is a common form of extrapulmonary TB (EXPTB). It is being reported increasingly, especially in high-burden regions of the world. We present a case of a 37-year-old male who presented to the emergency department with clinical features suggestive of bowel obstruction. On clinical examination, the patient exhibited generalized tenderness in the abdomen. A subsequent CT scan revealed features consistent with small bowel obstruction. The patient underwent a diagnostic laparoscopy, which was converted to an exploratory laparotomy due to intraoperative findings of adhesions. Notably, there were extensive peritoneal deposits and adhesions between bowel loops. Peritoneal biopsies were obtained and subjected to the acid-fast bacillus (AFB) smear and culture, which demonstrated the growth of the Mycobacterium tuberculosis complex. As a result, the patient was initiated on antituberculous therapy.
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Affiliation(s)
- Ammara S Sahibole
- Department of General Practice, Dubai Academic Health Corporation, Dubai, ARE
| | - Rihab Farooq
- Department of Medicine, Dubai Academic Health Corporation, Dubai, ARE
| | - Hafsa M Ali
- Department of Medicine, Thumbay University Hospital, Ajman, ARE
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Sudcharoen A, Ruchikajorndech G, Srisajjakul S, Pongpaibul A, Ngamskulrungroj P, Tulyaprawat O, Limsrivilai J. Clinical characteristics and diagnosis of intestinal tuberculosis in clinical practice at Thailand's largest national tertiary referral center: An 11-year retrospective review. PLoS One 2023; 18:e0282392. [PMID: 37053242 PMCID: PMC10101504 DOI: 10.1371/journal.pone.0282392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/12/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Diagnosing intestinal tuberculosis (ITB) is challenging due to the low diagnostic sensitivity of current methods. This study aimed to assess the clinical characteristics and diagnosis of ITB at our tertiary referral center, and to explore improved methods of ITB diagnosis. METHODS This retrospective study included 177 patients diagnosed with ITB at Siriraj Hospital (Bangkok, Thailand) during 2009-2020. RESULTS The mean age was 49 years, 55.4% were male, and 42.9% were immunocompromised. Most diagnoses (108/177) were made via colonoscopy; 12 patients required more than one colonoscopy. Among those, the sensitivity of tissue acid-fast bacilli (AFB), presence of caseous necrosis, polymerase chain reaction (PCR), and culture was 40.7%, 13.9%, 25.7%, and 53.4%, respectively. Among patients with negative tissue histopathology, 4 (3.7%) and 13 (12.0%) were ITB positive on tissue PCR and culture, respectively. The overall sensitivity when all diagnostic methods were used was 63%. Seventy-six patients had stool tests for mycobacteria. The overall sensitivity of stool tests was 75.0%. However, when analyzing the 31 patients who underwent both endoscopy and stool testing, the sensitivity of stool testing when using tissue biopsy as a reference was 45.8%. Combining stool testing and tissue biopsy did not significantly increase the sensitivity compared to tissue biopsy alone (83.9% vs. 77.4%, respectively). CONCLUSION Despite the availability of PCR and culture for TB, the overall diagnostic sensitivity was found to be low. The sensitivity increased when the tests were used in combination. Repeated colonoscopy may be beneficial. Adding stool mycobacteria tests did not significantly increase the diagnostic yield if endoscopy was performed, but it could be beneficial if endoscopy is unfeasible.
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Affiliation(s)
- Asawin Sudcharoen
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Srinakarinwirot University, Nakhon Nayok, Thailand
| | - Gahwin Ruchikajorndech
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orawan Tulyaprawat
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julajak Limsrivilai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Aregawi AB, Alem AT, Girma A. A Rare Case of Intestinal Tuberculosis with Chronic Partial Small Bowel Obstruction in a 37-Year-Old Ethiopian Man. Int Med Case Rep J 2022; 15:725-733. [PMID: 36540622 PMCID: PMC9759974 DOI: 10.2147/imcrj.s388269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/03/2022] [Indexed: 01/25/2024] Open
Abstract
Tuberculosis (TB) is a chronic granulomatous inflammatory disease that affects any part of our body. TB is a significant problem in developing countries. Intestinal TB accounts for 2% of TB cases worldwide. Terminal ileum and cecum are the two commonly affected regions because of abundant lymphoid tissue, physiologic stasis, limited digestive activity and increased fluid and electrolyte absorption rate. Intestinal obstruction is the leading complication of intestinal TB, and it occurs because of intestinal luminal narrowing, multiple strictures or adhesions. The clinical presentation of patients with intestinal TB and post-TB intestinal obstruction is non-specific. It can be acute, chronic, or acute on chronic. Uncomplicated cases of intestinal TB can be managed medically. Surgery is reserved for complicated cases of intestinal TB, which includes peritonitis, intestinal obstruction and perforations. Here, we present a 37-year-old man who presented with long-standing, intermittent crampy abdominal pain and vomiting. He was diagnosed with chronic partial small bowel obstruction secondary to possibly small bowel carcinoma. We did segmental ileal resection and end-to-end ileo-ileal anastomosis. Postoperatively, the histopathology result turned out to be intestinal TB. This case report aims to make physicians aware of the rare condition of small bowel obstruction secondary to intestinal TB. Clinicians need to have a high index of suspicion in any patient with long-standing symptoms of partial obstruction and consider surgery and anti-TB once diagnosed.
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Affiliation(s)
- Alazar Berhe Aregawi
- Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Alemwosen Teklehaimanot Alem
- Department of Pathology, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Abdulkerim Girma
- Department of Radiology, Yanet Internal Medicine Specialized Centre, Hawassa, Sidama, Ethiopia
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7
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Liu PG, Chen XF, Feng PF. Rectal cancer combined with abdominal tuberculosis: A case report. World J Clin Cases 2022; 10:11523-11528. [PMID: 36387825 PMCID: PMC9649531 DOI: 10.12998/wjcc.v10.i31.11523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/29/2022] [Accepted: 09/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is very rare to suffer from colorectal adenocarcinoma and abdominal tuberculosis simultaneously. Even in a country such as China, where tuberculosis is still endemic, its diagnosis and treatment are challenging. This article describes in detail a case of rectal cancer complicated by abdominal tuberculosis and its pathological features. CASE SUMMARY We outline the case of a 71-year-old female who was admitted with intermittent blood in the stool over the past year. The patient was diagnosed with low rectal cancer and received neoadjuvant therapy. The patient then returned to the hospital for surgery, but diffusely distributed nodules were found during laparoscopic exploration. The diagnosis of rectal cancer with extensive metastasis was considered during the operation. There was no opportunity for radical surgery. Thus, nodules were taken for pathological examination, and the abdomen was closed. The histopathological diagnosis was tuberculous granuloma, and the patient was treated with standardized anti-tuberculosis drugs in a specialized hospital. Later, the patient again came to our hospital and underwent abdominoperineal resection. She was discharged 10 d after the operation in good clinical condition. CONCLUSION We aim to emphasize the importance of preoperative and postoperative pathological examination in diagnosis and treatment.
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Affiliation(s)
- Pei-Gen Liu
- Department of General Surgery, Central Hospital of Panzhihua City, Panzhihua 617000, Sichuan Province, China
| | - Xiang-Fan Chen
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Pan-Feng Feng
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
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8
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Di Buono G, Vella R, Amato G, Romano G, Rodolico V, Saverino M, De Lisi G, Romano G, Buscemi S, Agrusa A. Totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation: The first case report in worldwide literature with a brief review. Front Surg 2022; 9:956124. [PMID: 36017513 PMCID: PMC9395922 DOI: 10.3389/fsurg.2022.956124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Bowel perforation is a relatively rare presentation of abdominal tuberculosis, whose diagnosis is challenging but fundamental to minimize morbidity and mortality. Laparoscopy is considered an effective modality for diagnosis, but its role in surgical treatment is still not established. We reported the first worldwide case of totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation. CASE PRESENTATION A 30-year-old man with a history of weight loss, preceded by 2 years of nonproductive cough, was admitted to the Infectious Disease Department with a presumed diagnosis of tuberculosis. A microbiological culture test confirmed the diagnosis, and the patient undertook quadruple antituberculous therapy. During hospitalization, he presented sudden abdominal pain, fever, and vomit. An abdominal CT scan showed small bowel perforation with granulomatous reaction. Laparoscopy was performed and revealed a 2 cm perforation on the medium ileum. Small bowel resection and totally intracorporeal side-to-side anastomosis were performed. No complication occurred until a clinical follow-up of 2 months. CONCLUSION In consideration of the increasing incidence of intestinal TB in both underdeveloped and Western countries, the diagnosis of this pathology should be taken into account in high-risk patients. Probably, the diagnostic challenges and emergency settings of intestinal TB with perforation and peritonitis, together with the lack of standardized guidelines regarding surgical management, make the use of laparoscopy apparently arduous, but the known advantages of laparoscopy and its technical feasibility should make it a conceivable option for the treatment of complicated cases.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Roberta Vella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Amato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vito Rodolico
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, Palermo, Italy
| | - Marta Saverino
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giovanni De Lisi
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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9
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Morgan AA, Mahmood A, Russell GK, Kon OM. Intestinal perforation due to miliary tuberculosis in a patient with myasthenia gravis. BMJ Case Rep 2022; 15:e249547. [PMID: 35868806 PMCID: PMC9315895 DOI: 10.1136/bcr-2022-249547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/03/2022] Open
Abstract
A man in his early 70s presented to the emergency department with a fall, following a history of fatigue and malodorous urine. On presentation, he was feverish, tachycardic and confused and was treated for presumed urinary sepsis. A chest radiograph showed increased opacification in the left upper lobe with calcification. CT imaging and bronchoalveolar lavage demonstrated miliary tuberculosis infection. His background included myasthenia gravis, which led to challenges in selecting appropriate antituberculosis treatment. During his stay, he developed sudden-onset abdominal pain due to intestinal perforation. He subsequently deteriorated and underwent multiple interventions, including a Hartmann's procedure and ileocaecal resection. Histological examination of his sigmoid colon revealed abundant acid-fast bacilli. Unfortunately, the patient died due to multiorgan failure in the context of several complications. This case highlights intestinal perforation as a rare complication of miliary tuberculosis and emphasises the importance of being vigilant for this potential complication.
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Affiliation(s)
| | - Adil Mahmood
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Georgina K Russell
- Chest & Allergy Clinic, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Onn Min Kon
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
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10
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Niranjan N, George R. Gastrointestinal tuberculosis presenting as a diagnostic dilemma with unusual sequalae of Posterior Reversible Encephalopathy Syndrome. ANZ J Surg 2022; 92:2341-2343. [PMID: 35005828 DOI: 10.1111/ans.17462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nithya Niranjan
- General Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Robert George
- General Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
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11
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Shams AH, Niakan MH, Ahadi M, Rasekhinejad M, Sardar Kermani S. Small Bowel Obstruction As a Consequence of Peritoneal Tuberculosis. Bull Emerg Trauma 2022; 10:196-200. [PMID: 36568716 PMCID: PMC9758706 DOI: 10.30476/beat.2021.91273.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 12/27/2022] Open
Abstract
Peritoneal tuberculosis (PTB) is a rare subset of extrapulmonary tuberculosis which account for only 0.5-1% of all cases. PTB diagnosis can be challenging due to nonspecific clinical manifestations. We present a known case of pulmonary tuberculosis that admitted to the surgery ward due to the major complaint of abdominal pain since ten days before admission. In imaging studies, positive findings favoring mechanical obstruction were detected. There were also several hypodense lesions in the liver suggestive of visceral tuberculosis. An adhesion was noted during exploratory laparotomy prior to the ileocecal valve responsible for intestinal obstruction, which was released. Pathology reports of excised tissues were consonant with the PTB diagnosis. PTB diagnosis can be challenging because of its presentation. This can delay the treatment of patients and thus increase morbidity and mortality. As a result, physicians should always be aware of the PTB diagnosis in patients with nonspecific abdominal involvement.
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Affiliation(s)
- Amir Hossein Shams
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Ahadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Rasekhinejad
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Majid Rasekhinejad Address: Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. e-mail:
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12
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Ionescu S, Nicolescu AC, Madge OL, Marincas M, Radu M, Simion L. Differential Diagnosis of Abdominal Tuberculosis in the Adult-Literature Review. Diagnostics (Basel) 2021; 11:2362. [PMID: 34943598 PMCID: PMC8700228 DOI: 10.3390/diagnostics11122362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) is a public health issue that affects mostly, but not exclusively, developing countries. Abdominal TB is difficult to detect at first, with the incidence ranging from 10% to 30% of individuals with lung TB. Symptoms are non-specific, examinations can be misleading, and biomarkers commonly linked with other diseases can also make appropriate diagnosis difficult. As a background for this literature review, the method used was to look into the main characteristics and features of abdominal tuberculosis that could help with differentiation on the PubMed, Science Direct, and Academic Oxford Journals databases. The results were grouped into three categories: A. general features (the five forms of abdominal tuberculosis: wet and dry peritonitis, lymphadenopathy, lesions at the level of the cavitary organs, lesions at the level of the solid organs), B. different intra-abdominal organs and patterns of involvement (oesophageal, gastro-duodenal, jejunal, ileal, colorectal, hepatosplenic, and pancreatic TB with calcified lymphadenopathy, also with description of extraperitoneal forms), and C. special challenges of the differential diagnosis in abdominal TB (such as diagnostic overlap, the disease in transplant candidates and transplant recipients, and zoonotic TB). The study concluded that, particularly in endemic countries, any disease manifesting with peritonitis, lymphadenopathy, or lesions at the level of the intestines or solid organs should have workups and protocols applied that can confirm/dismiss the suspicion of abdominal tuberculosis.
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Affiliation(s)
- Sinziana Ionescu
- 1st Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (S.I.); (L.S.)
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Octavia Luciana Madge
- 1st Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (S.I.); (L.S.)
| | - Marian Marincas
- 1st Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (S.I.); (L.S.)
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Madalina Radu
- Pathology Department, Bucharest Oncology Institute, 022328 Bucharest, Romania;
| | - Laurentiu Simion
- 1st Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (S.I.); (L.S.)
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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13
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Barot M, Yagnik VD, Patel K, Dawka S. Surgical management of abdominal tuberculosis: A prospective single-center study. Tzu Chi Med J 2021; 33:282-287. [PMID: 34386367 PMCID: PMC8323646 DOI: 10.4103/tcmj.tcmj_206_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Tuberculosis (TB) can affect any part of the gastrointestinal tract. It is estimated that in 2018, 10 million people were affected with TB worldwide and there were 1.2 million TB deaths among human immunodeficiency virus-negative people. India has the highest TB burden in the world (27%), a significant proportion of which are of intestinal TB. The aims of this study were to assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and its management. MATERIALS AND METHODS From October 1, 2014, to October 30, 2016, a total of 50 patients meeting the inclusion criteria for the study, age between 15 and 65 years and diagnosis of symptomatic intestinal TB requiring surgery, were enrolled in the study. We used descriptive statistics to analyze the data. RESULTS Abdominal TB was most commonly seen in young adults. Intestinal obstruction was the most frequent presentation. The most common site of involvement in the present study was the ileum. Ultrasonography (USG) and X-ray were an integral part of the diagnosis, with computed tomography (CT) scan being rarely required. Although both anemia and erythrocyte sedimentation rate (ESR) are nonspecific, they may help in supporting the clinical and pathological findings. Most operations were elective, with intestinal obstruction being the most common indication and resection and end-to-end anastomosis performed most often. Histopathological examination was performed in all patients and showed caseating granuloma in 90% of cases, while 10% of cases had chronic noncaseating granulomas with ill-defined aggregates of epithelioid histiocytes. CONCLUSION Abdominal TB causes a significant problem in diagnosis due to nonspecific symptomatology and lack of specific laboratory tests. USG and X-ray were an integral part of the diagnosis. CT scan is rarely required. Although anemia and ESR are both nonspecific features, they may help in supporting the clinical and pathological findings. The most common site of involvement in the present study was the ileum. Intestinal obstruction was the most common indication for operation, with resection and end-to-end anastomosis being the most common operation. The mainstay of treatment is medical therapy and timely surgical intervention is required in a sizable number of patients.
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Affiliation(s)
- Mithun Barot
- Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Vipul D. Yagnik
- Department Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
| | - Kirankumar Patel
- Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
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Mousa H, Abdel-Kader S, Abu-Zidan FM. Management of abdominal tuberculosis in a community-based hospital in a high-income developing country. World J Emerg Surg 2021; 16:25. [PMID: 34039395 PMCID: PMC8153524 DOI: 10.1186/s13017-021-00370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates. Methods All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died. Conclusions Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.
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Affiliation(s)
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE.
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15
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A LIP Abdominal Tuberculosis Classification System for Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Dudaka A, Sundaramurthi S, Vijayakumar C, Elamurugan TP, Jagdish S. Coinfection of Typhoid Fever With Tuberculosis: A Challenge to Surgical Management. Cureus 2020; 12:e8540. [PMID: 32670677 PMCID: PMC7357349 DOI: 10.7759/cureus.8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ileal perforation is one of the most dreaded complications of abdominal tuberculosis. It is more common in immunodeficient patients, where ulcerative type of intestinal tuberculosis predominates. Various factors play role in the outcome of these patients, such as age and comorbid illness, though the lag period (advent of symptoms to time of admission to hospital) correlated directly to the mortality in these patients. Herein we present a 28-year-old male who had a coinfection of typhoid fever along with intestinal tuberculosis. The patient presented with abdominal pain and fever for one-week duration. On examination, he had diffuse tenderness of his abdomen with guarding. X-ray revealed free air under diaphragm. The patient underwent limited resection of terminal ileum and cecum with end ileostomy for ileal perforation. The patient’s serum Widal test was positive and blood culture grew Salmonella Typhi, and the patient was started on intravenous (IV) antibiotics based on culture and sensitivity. The patient’s general condition worsened after two weeks with bile leak from the surgical site. The patient succumbed to severe sepsis. Postoperative histopathology of the resected ileo-cecal segment showed features of ileo-cecal tuberculosis. As typhoid is a common cause of ileal perforation in the developing countries, the co-existence of typhoid fever in this patient lead to the delay in the diagnosis and appropriate management of tubercular ileal perforation. Knowledge about various causes of typhoid perforation is essential for treating surgeons.
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Affiliation(s)
- Anusha Dudaka
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - T P Elamurugan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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17
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Fu KH, Liaw GW. Abdominal Tuberculosis Managed Surgically in the Late Phase: A Case Report. J Acute Med 2020; 10:40-44. [PMID: 32995153 PMCID: PMC7517950 DOI: 10.6705/j.jacme.202003_10(1).0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 05/28/2023]
Abstract
About 1-5 % of cases of tuberculosis (TB) have uncommon abdominal conditions, and affect primarily young adults. The clinical diagnosis is challenging and often delayed due to the symptoms being non-specific and may be confused with other bowel diseases, therefore resulting in significant morbidity and mortality. A 27-year-old man was brought to our emergency department with the complaints a fever and abdominal pain. According to the chest X-ray findings taken 24 hours previously, pulmonary TB was suspected. Abdominal TB associated intestinal obstruction, ascites and lymphadenopathy were found by computed tomography and exploratory laparotomy. He was treated surgically by segmental resection, however passed away due to severe bleeding caused by the recurrence of perforation of the small intestine and sepsis. This case of systemic TB highlights the difficulties in diagnosis and treatment in time. The early diagnosis and timely treatment are both necessary to manage the disease successfully.
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Affiliation(s)
- Ken-Hui Fu
- Department of Medicine Yee-Zen Hospital Taoyuan Taiwan
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18
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Ahamed Z R, Shah J, Agarwala R, Kumar-M P, Mandavdhare HS, Gupta P, Singh H, Sharma A, Dutta U, Sharma V. Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification. Expert Rev Anti Infect Ther 2019; 17:547-555. [PMID: 31293195 DOI: 10.1080/14787210.2019.1642746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Peritoneal tuberculosis is a common type of abdominal tuberculosis. The most commonly used classification divides peritoneal tuberculosis into wet-ascitic type, dry-plastic type, and fixed-fibrotic type. Areas covered: We performed a systematic literature search on the definitions of existing classification of peritoneal tuberculosis. The literature search identified confusion in the classification of peritoneal tuberculosis. The classification system also fails to classify some patterns of peritoneal tuberculosis like an abdominal cocoon and a substantial overlap in various categories was found. The impact of the present classification on clinical management is unclear. Lack of prospective studies and the presence of heterogeneity in reporting add to the confusion. Expert opinion: We suggest that a uniform system which better classifies peritoneal tuberculosis and helps in clinical management should be used in future studies. We propose a simple, clinico-radiological classification of peritoneal tuberculosis into two types: distension-dominant and/or pain-obstruction dominant based on the clinical presentation. This approach will be relevant to clinicians as patients with the pain-obstruction dominant presentation are more likely to receive surgical interventions and may benefit from additional measures aimed to reduce fibrosis-like addition of steroids to ATT. Future studies should aim to validate the proposed clinico-radiological classification in patients with peritoneal tuberculosis.
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Affiliation(s)
- Rizwan Ahamed Z
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Jimil Shah
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Roshan Agarwala
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Praveen Kumar-M
- b Department of Pharmacology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Harshal S Mandavdhare
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Pankaj Gupta
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Harjeet Singh
- c Department of General Surgery, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Aman Sharma
- d Department of Internal Medicine, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Usha Dutta
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Vishal Sharma
- a Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
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19
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20
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Tuberculosis Mimicking Disseminated Peritoneal Carcinomatosis of a Sigmoid Carcinoma. J Gastrointest Surg 2019; 23:877-878. [PMID: 29736664 DOI: 10.1007/s11605-018-3800-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND A 76-year-old Moroccan patient with a medical history of sigmoid carcinoma suffered from weight loss of 15 kg and abdominal pain. Laparoscopy showed disseminated miliary peritoneal lesions, prima vista suspicious for disseminated peritoneal cancer spread. METHODS Patient's medical history was reprocessed and compared to recent literature via PubMed. RESULTS Pathological evaluation revealed granulomas and an infection with miliary intraabdominal tuberculosis (TB) was proven. CONCLUSION Symptoms of TB may vary and findings can be misleading. An interdisciplinary approach is needed for diagnosis and treatment.
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21
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Zhu LB, Zhang YY, Li JQ, Li PF, Zhang PB, Jin JW. Treatment of an incarcerated inguinal hernia associated with abdominal tuberculosis in an adult patient. J Int Med Res 2018; 46:3474-3479. [PMID: 30019613 PMCID: PMC6134657 DOI: 10.1177/0300060518786628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of tuberculosis is increasing worldwide, especially in developing countries. The prevalence of abdominal tuberculosis has been found to be as high as 12% in people with extrapulmonary tuberculosis. Peritoneal thickening and intestinal adhesions can occur in patients with abdominal tuberculosis. Inguinal hernias are extremely rare in people with abdominal tuberculosis; only 11 cases have been reported in the English-language literature, half of which involved pediatric patients. No definitive guideline on the management of such cases is available. In this report, we describe the unusual finding of an incarcerated inguinal hernia in an adult with abdominal tuberculosis and propose a therapy to treat this complicated disease based on our successful experience.
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Affiliation(s)
- Lin-Bo Zhu
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Yuan-Yan Zhang
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Jun-Qiang Li
- 2 Department of Pathology, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Peng-Fei Li
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Peng-Bin Zhang
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Jia-Wei Jin
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
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Moreno-Corrales M, Gómez-Landa F, Sánchez-Valdivieso E. Tuberculosis tubaria y peritoneal que simula carcinomatosis. Linfopenia con trombocitosis como auxiliar en el diagnóstico diferencial. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim YI, Jang JY, Shim H, Bae KS. Abdominal Tuberculosis Combined with Abdominal Trauma. JOURNAL OF ACUTE CARE SURGERY 2017. [DOI: 10.17479/jacs.2017.7.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Young Ik Kim
- Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hongjin Shim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Montravers P, Tashk P, Tran Dinh A. Unmet needs in the management of intra-abdominal infections. Expert Rev Anti Infect Ther 2017; 15:839-850. [PMID: 28841096 DOI: 10.1080/14787210.2017.1372750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Intra-abdominal infections remain a leading cause of death, morbidity and resource use in surgical wards and intensive care units. The growing complexity of their management has led to new paradigms and unresolved issues in anti-infective therapy described in the current review. Areas covered: We analyzed the literature, recent guidelines, and expert opinions published over the last decade. Expert commentary: Prospective randomized trials are difficult to perform and observational studies or database analyses should be encouraged. Epidemiologic and microbiologic reports should be promoted, especially in developing/resource-limited countries and in specific subpopulations such as children, older people and patients with underlying diseases. The diagnostic process, including imaging procedures, could be improved. The value of biomarkers for diagnosis, monitoring and discontinuation of therapy should be clarified and improved. New microbiologic techniques are needed to speed up the diagnostic process and to improve the adequacy of anti-infective therapy. Very little progress has been made in the detection of clinical failures. Many aspects of anti-infective management, both for bacteria and fungi, remain unresolved, such as the high inoculum, the type of microorganisms to be treated, the timing of therapy, the value of de-escalation, drug monitoring and duration of therapy. New antibiotics are expected.
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Affiliation(s)
- Philippe Montravers
- a Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine , Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP , Paris , France.,b INSERM UMR 1152 , Paris , France
| | - Parvine Tashk
- a Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine , Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP , Paris , France
| | - Alexy Tran Dinh
- a Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine , Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP , Paris , France.,c INSERM UMR 1148 , Paris , France
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25
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Weledji EP, Pokam BT. Abdominal tuberculosis: Is there a role for surgery? World J Gastrointest Surg 2017; 9:174-181. [PMID: 28932351 PMCID: PMC5583525 DOI: 10.4240/wjgs.v9.i8.174] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/17/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
It is important that surgeons are familiar with the various manifestations of tuberculosis (TB). Although TB has been declining in incidence in the developed world, it remains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
| | - Benjamin Thumamo Pokam
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
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26
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What remains to surgeons in the management of abdominal tuberculosis? A 10 years experience in an endemic area. Indian J Tuberc 2017; 64:167-172. [PMID: 28709483 DOI: 10.1016/j.ijtb.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/28/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a common endemic disease in Tunisia. Abdominal location is rare. Early diagnosis of abdominal TB remains difficult due to its non-specific clinical presentations. The aim of our study is to highlight the characteristics of the different presentations, to characterize tools contributing to a positive preoperative diagnosis, and finally to assess the role of surgery in the management of this entity. MATERIALS AND METHODS A retrospective review from 2005 to 2015 identified 90 cases of confirmed abdominal TB managed in the Department of General Surgery of the Habib Thameur Hospital. The diagnosis was established by histopathology examination for all cases. This study was approved by the ethical committee. RESULTS The mean age of the patient was 44.13 years with a sex ratio (M/F) of 0.34. We collected 56 cases of peritoneal TB, 12 cases of abdominal lymph node TB, 10 cases of intestinal TB, four cases of hepatic TB, and two cases of gallbladder's TB. For six patients, an association of many localizations was noted. The diagnosis was suspected on clinical, biological, and morphological arguments, but the confirmation was always made by surgical exploration and pathological examination of removed specimens. Surgical management was urgent in complicated cases (13.3%). Laparoscopy was performed in 71 cases (78.9%). Laparoscopic features of peritoneal TB were specific and always confirmed by histological examination. CONCLUSION Despite the wide range of examination available for the preoperative exploration of abdominal TB, diagnosis is usually late and difficult. TB is a medical condition. However, surgical exploration is frequently needed in the management.
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Sousa MD, Batista J, Pacheco P, Nunes V. Abdominal tuberculosis: an old disease surprising young doctors. BMJ Case Rep 2016; 2016:bcr-2016-216057. [PMID: 27807019 DOI: 10.1136/bcr-2016-216057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay the diagnosis and treatment. We present the case of an adult woman admitted to the emergency department with bowel obstruction. The putative intraoperative diagnostic hypothesis was ovarian cancer with peritoneal dissemination. Histopathological analysis showed a chronic granulomatous inflammatory disease with acid-fast bacilli. The patient was started on an alternative parenteral antituberculosis drug combination until oral feeding was available. Currently, 5 months after surgery, she is asymptomatic. Abdominal tuberculosis is the most frequent extrapulmonary site with a wide range of clinical presentations. Emergency laparotomy may be necessary in patients who present with acute abdomen. Bowel obstruction due to adhesions and strictures is not infrequent. However, tuberculous abdominal cocoon presentation as in our patient is rare. Treatment with parenteral alternative drug regimens for tuberculosis is mandatory until the oral route is available.
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Affiliation(s)
- Marta David Sousa
- B Surgery Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Lisboa, Portugal
| | - Joana Batista
- Department of Infectious Disease, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Lisboa, Portugal
| | - Patricia Pacheco
- Department of Infectious Disease, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Lisboa, Portugal
| | - Vitor Nunes
- Department of Surgery-Cirurgia B, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
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28
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Evans RPT, Mourad MM, Dvorkin L, Bramhall SR. Hepatic and Intra-abdominal Tuberculosis: 2016 Update. Curr Infect Dis Rep 2016; 18:45. [PMID: 27796776 DOI: 10.1007/s11908-016-0546-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mycobacterium tuberculosis (TB) infection affects nearly 10 million people a year and causes 1.5 million deaths. TB is common in the immunosuppressed population with 12 % of all new diagnoses occurring in human immune deficiency virus (HIV)-positive patients. Extra-pulmonary TB occurs in 12 % of patients with active TB infection of which 3.5 % is hepatobiliary and 6-38 % is intra-abdominal. Hepatobiliary and intra-abdominal TB can present with a myriad of non-specific symptoms, and therefore, diagnosis requires a high level of suspicion. Accurate and rapid diagnosis requires a multidisciplinary team (MDT) approach using radiology, interventional radiology, surgery and pathology services. Treatment of TB is predominantly medical, yet surgery plays an important role in managing the complications of hepatobiliary and intra-abdominal TB.
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Affiliation(s)
- Richard P T Evans
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Moustafa Mabrouk Mourad
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Lee Dvorkin
- North Middlesex University Hospital, London, UK
| | - Simon R Bramhall
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK.
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Tuberculosis, one more consideration in the differential diagnosis of a pancreatic mass. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:619-621. [PMID: 27743782 DOI: 10.1016/j.gastrohep.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/11/2016] [Accepted: 08/14/2016] [Indexed: 01/09/2023]
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