Case report: a case report and literature analysis on intestinal tuberculosis intestinal perforation complicated by umbilical intestinal fistula and bladder ileal fistula.

BACKGROUND: Intestinal tuberculosis is a chronic and specific infection caused by Mycobacterium tuberculosis invading the intestine. Due to the nonspecific clinical presentation, it is stressed that intestinal perforation complicates umbilical intestinal fistula and bladder ileal fistula is very rare and extremely difficult to be diagnosed. It is significant to identify the disease and take urgent intervene in the early stage. CASE PRESENTATION: An 18-month-old boy patient presented with abdominal pain. Abdominal CT suggested abscess formation in the right lower abdomen and pelvis. The patient underwent resection of necrotic and stenotic intestinal segments with the creation of an ileostomy, cystostomy and vesicoureteral fistula repair for the presence of intestinal perforation complicated by vesicoureteral fistula and umbilical enterocutaneous fistula. Histopathology confirmed the intestinal tuberculosis. The patient was discharged successfully after 11 days post anti-tuberculosis treatment. CONCLUSION: Our case report here is a rare case of umbilical intestinal fistula with bladder ileal fistula secondary to intestinal perforation from intestinal tuberculosis. The purpose of this report is to make the surgical community aware of atypical presentations of intestinal tuberculosis. If our peers encounter the similar situation, they can be prepared for corresponding diagnosis and treatment.

Mini-laparoscopy as a diagnostic tool for abdominal tuberculosis: a retrospective series of 29 cases.

OBJECTIVES: Abdominal tuberculosis (TB) is a "great mimic," and diagnosis remains challenging even for experienced clinicians. While mini-laparoscopy has already been demonstrated to be an efficient diagnostic tool for a variety of diseases, we aimed to demonstrate the feasibility of this technique in diagnosing abdominal TB. METHODS: We retrospectively included patients who underwent mini-laparoscopy at the University Medical Center Hamburg-Eppendorf between April 2010 and January 2022 for suspected abdominal TB. Demographic, clinical, and laboratory data, radiological findings as well as macroscopic, histopathologic, and microbiologic results were analyzed by chart review. RESULTS: Out of 49 consecutive patients who underwent mini-laparoscopy for suspected abdominal TB, the diagnosis was subsequently confirmed in 29 patients (59%). Among those, the median age was 30 years (range 18-86 years) and the majority were male (n = 22, 76%). Microbiological diagnosis was established in a total of 16 patients. The remaining patients were diagnosed with abdominal TB either by histopathological detection of caseating granulomas (n = 3), or clinically by a combination of typical presentation, mini-laparoscopic findings, and good response to anti-tuberculous treatment (n = 10). Bleeding from the respective puncture site occurred in 19 patients (66%) and either resolved spontaneously or was arrested with argon plasma coagulation alone (n = 10) or in combination with fibrin glue (n = 1). Minor intestinal perforation occurred in 2 patients and was treated conservatively. CONCLUSIONS: Mini-laparoscopy is a useful and safe modality for the diagnosis of abdominal TB.

Clinical features and diagnostic approaches for abdominal tuberculosis: five-year experience from a non-tuberculosis-designated hospital in China.

BACKGROUND AND PURPOSE: abdominal tuberculosis (TB) is a common form of extrapulmonary TB but it is still a diagnostic dilemma in clinical practice. This study aimed to highlight the clinical features and diagnostic approaches for abdominal TB. METHODS: seventy cases of diagnosed abdominal TB were retrospectively collected between August 1st, 2015 and June 30th, 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB or mixed TB. RESULTS: eighteen patients were diagnosed with peritoneal TB, nine with lymph node TB, five with gastrointestinal TB, two with visceral TB and 36 with mixed TB. More than 65 % of the patients had tuberculosis of other sites except the abdomen. The median diagnosis time was 60 days. Ascites (58.6 %), abdominal distension (48.6 %), weight loss (44.3 %) and fever (42.9 %) were the most common symptoms. The overall microbiological and histological detection rates were 70.0 % and 38.6 %, respectively. The non-ascite samples yielded a higher microbiological confirmation rate (63.6 %) than the total samples (40.8 %). Diagnosis was confirmed histologically in 18 patients (69.2 %). Forty-five cases (64.3 %) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates. CONCLUSIONS: the diagnosis of abdominal TB should be reached by a combination of clinical, laboratory, radiological, microbiological and pathological findings.

[Abdominal tuberculosis in children]. / Abdominal'nyi tuberkulez u detei.

OBJECTIVE: To determine the features of diagnosis and clinical course of abdominal tuberculosis in children. MATERIAL AND METHODS: Eighteen children aged from 5 days to 16 years with abdominal tuberculosis have been followed-up throughout 50 years. Diagnostic process implied anamnesis, objective examination, laboratory data and specific samples, ultrasound, X-ray examination, MRI, CT and morphological examination of specimens. RESULTS: Intestinal form was diagnosed in 2 children with abdominal tuberculosis, mesadenitis - 3 patients, liver tuberculosis - 4 ones, tuberculosis of uterine appendages - 3 patients, peritonitis - 6 ones. CT of the abdomen, diaskintest and morphological examination were the most important diagnostic methods. Laparotomy was performed in 16 children. Five cases are decsribed. CONCLUSION: Abdominal tuberculosis in children is mostly secondary. Several anatomical regions are simultaneously involved in specific process. Isolated lesion of one abdominal organ is rare. Active tuberculosis of respiratory organs in pregnant women has a significant negative impact on the fetus and newborns.

Vulvar lymphangiectasia secondary to gastrointestinal tuberculosis infection in a teenager.

We report a rare presentation of vulvar lymphangiectasia that developed secondary to gastrointestinal tuberculosis in a teenager, and its spontaneous resolution after anti-tuberculous treatment was completed.

Laparoscopy In Unexplained Abdominal Pain: Surgeon's Perspective.

BACKGROUND: Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. METHODS: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. RESULTS: Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. CONCLUSIONS: Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients.

Clinico-Pathological Profile and Surgical Outcome of Patients of Gastrointestinal Tuberculosis Undergoing Laparotomy.

Tuberculosis is one of the earliest diseases affecting the mankind. Abdominal tuberculosis constitutes a common public health issue in developing countries like ours. Gastrointestinal tuberculosis often involves the ileocecal region. Surgery in case of abdominal tuberculosis is required to overcome the deleterious effects of the disease like tissue disorganization, obstruction and perforatio. AIMS AND OBJECTIVES: 1. To study the various clinical profiles of gastrointestinal tuberculosis in patients undergoing laparotomy; 2. To study the surgical pathology of gastrointestinal tuberculosis; 3. To study the various surgical treatment modalities based upon the intraoperative findings and its outcome. Results: This is a prospective study over 12 months at Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun. This study was done to study the clinic-pathological profile of gastrointestinal tuberculosis undergoing laparotomy. Incidence of gastro intestinal tuberculosis was seen highest in age group 15 to 25 years with male predominance. Most commonly presentation being intestinal obstruction with ileo-caecal as the most common area involved and right hemicolectomy as the commonest procedure done. Common surgical pathologies were ileo-caecal mass and ileal perforation and this also has relation to pulmonary tuberculosis. CONCLUSION: Inspite of specific antituberculous drugs and vast measures against the disease, including chemoprophylaxis and pasteurisation abdominal tuberculosis remains a fairly common disease even today. Gastrointestinal tuberculosis has an indolent course and the common mode of presentation is usually sub acute or chronic. Prompt surgical exploration, vigilant postoperative care and administration of ATD helped to treat the patients successfully with their complete cure and rehabilitation.

Lessons from emergency laparotomy for abdominal tuberculosis in the HIV/AIDS era.

BACKGROUND: The rising incidence of HIV/AIDS has resulted in a resurgence of abdominal tuberculosis (TB) in HIV-positive patients in South Africa. These often debilitated patients frequently present with acute complications requiring surgery. METHODS: A prospective audit of all patients with abdominal TB undergoing emergency laparotomy was conducted. From January 2008 to June 2010, 49 patients had emergency laparotomy and specimens obtained from them were diagnostic of TB. Twenty-five were males and 24 females, with a median age of 32 years (range 2 - 62). Thirty-nine patients were HIV-positive (79.6%). RESULTS: Intra-operative findings were bowel perforations in 13 cases, small-bowel obstruction in seven, a frozen abdomen in ten, and enlarged lymph nodes and an ileocaecal mass in 19. Eleven patients (22.4%) underwent small-bowel resection and eight (16.3%) right hemicolectomy. Eighteen patients (36.7%) ended up with stomas, 14 (28.6%) had re-laparotomies, and 18 (36.7%) were admitted to the intensive care unit. Twenty-three patients (46.9%) required blood transfusion and 15 (30.6%) total parenteral nutrition. Three patients (6.1%) developed an enterocutaneous fistula and 19 (38.8%) died. Pre-operative illness severity indices of acidosis, anaemia and hypo-albuminaemia were significant predictors of death, but mode of presentation and surgical interventions were not. CONCLUSION: Laparotomy as currently practised for the 'acute abdomen' in patients with suspected HIV and abdominal TB is associated with very high morbidity and mortality, which is related to pre-operative severity indices. More liberal use of imaging may define cases in which a more conservative approach could improve outcome.

Right Colectomy for an Inflammatory Mass in the Cecum Later Found to Be Tuberculosis.

Gastrointestinal tuberculosis (TB) is a rare manifestation of extra-pulmonary TB that is known to mimic many different gastrointestinal diseases. We present a case of an 85-year-old male patient with delayed diagnosis of gastrointestinal TB who underwent colonic resection for a cecal mass that was initially suspected to be malignant. Acid-fast staining of the surgical specimen later revealed acid-fast bacilli and multiple lymph nodes with necrotizing granulomas. The purpose of this study is to stress the importance of including gastrointestinal TB as a differential diagnosis for patients with suspected colorectal malignancy, especially when initial biopsy results do not reveal malignant features.

Clinicopathological profile and surgical treatment of abdominal tuberculosis: a single centre experience in northwestern Tanzania.

BACKGROUND: Abdominal tuberculosis continues to be a major public health problem worldwide and poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was conducted to describe the clinicopathological profile and outcome of surgical treatment of abdominal tuberculosis in our setting and compare with what is described in literature. METHODS: A prospective descriptive study of patients who presented with abdominal tuberculosis was conducted at Bugando Medical Centre (BMC) in northwestern Tanzania from January 2006 to February 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0. RESULTS: Out of 256 patients enrolled in the study, males outnumbered females. The median age was 28 years (range = 16-68 years). The majority of patients (77.3%) had primary abdominal tuberculosis. A total of 127 (49.6%) patients presented with intestinal obstruction, 106 (41.4%) with peritonitis, 17 (6.6%) with abdominal masses and 6 (2.3%) patients with multiple fistulae in ano. Forty-eight (18.8%) patients were HIV positive. A total of 212 (82.8%) patients underwent surgical treatment for abdominal tuberculosis. Bands /adhesions (58.5%) were the most common operative findings. Ileo-caecal region was the most common bowel involved in 122 (57.5%) patients. Release of adhesions and bands was the most frequent surgical procedure performed in 58.5% of cases. Complication and mortality rates were 29.7% and 18.8% respectively. The overall median length of hospital stay was 32 days and was significantly longer in patients with complications (p < 0.001). Advanced age (age ≥ 65 years), co-morbid illness, late presentation, HIV positivity and CD4+ count < 200 cells/µl were statistically significantly associated with mortality (p < 0.0001). The follow up of patients were generally poor as only 37.5% of patients were available for follow up at twelve months after discharge. CONCLUSION: Abdominal tuberculosis constitutes a major public health problem in our environment and presents a diagnostic challenge requiring a high index of clinical suspicion. Early diagnosis, early anti-tuberculous therapy and surgical treatment of the associated complications are essential for survival.

[The symptoms and surgical tactics for complicated forms of the abdominal cavity tuberculosis].

The results of treatment of 12 patients, suffering complicated forms of abdominal tuberculosis and external intestinal fistulas, were presented. Late diagnosis of abdominal tuberculosis in the patients, suffering the complications phase of the disease, is caused by unclear symptoms presence in early stages of the disease. Clinical and laboratory indices in peritonitis of a phthisis origin are nonspeciphic. In 91% of patients, admitted to the hospital for complicated forms of abdominal tuberculosis and external intestinal fistulas, the operative treatment was indicated. Surgical intervention (more frequently right-sided hemicolectomy, enterostomy, the abscesses opening, the caseously-changed lymph nodes excision, formation of anastomosis) was performed in 11 patients for peritonitis and external intestinal fistulas. The method of a secure invagination anastomoses formation was elaborated, permitting to perform primary restoration operations. An early diagnosis, early effective therapy and radical surgical intervention conduction for complicated abdominal tuberculosis promote the patients to survive.

Vascular anatomy of strictured small bowel.

AIM: To investigate the role of ischemia in the pathogenesis of small bowel strictures. METHODS: Vascular anatomy of 39 small bowel strictures was studied using modified Spalteholtz method. Ten normal small bowel segments were studied as controls. RESULTS: 71.8% of small bowel strictures showed block in the mesenteric vessels (p=0.008). Subset analysis of tuberculous strictures showed block in the mesenteric vessels in 70.8% of strictures (p=0.0098). CONCLUSIONS: Ischemia plays a significant role in the pathogenesis of small bowel strictures. Mesenteric vasculopathy has a significant association with tuberculous strictures of the intestine.

[Clinical diagnosis of HIV infection in patients with acute surgical diseases of the abdominal cavity organs and pulmonary tuberculosis].

The results of treatment of 81 patients, suffering tuberculosis and operated in emergency for an acute surgical diseases of the abdominal cavity organs, are adduced, in 29 of them--nonspecific diseases of nontuberculosis genesis were diagnosed. In 52 patients the indication for emergency operation performance were complications of abdominal tuberculosis (perforation of the tuberculosis ulcers of small intestine--in 37, the tuberculosis mesadenitis--in 15), of them in 34--pulmonary tuberculosis was in inactive phase, that's why the HIV presence was supposed. In 26 patients the diagnosis was confirmed, basing on serologic analysis data. The presence of intraabdominal catastrophe, caused by abdominal tuberculosis complications on inactive pulmonary tuberculosis background witnesses with 85.3% probability the HIV-infectioning of the patient.

Ileal perforation in a child with abdominal tuberculosis.

A 6-year-old boy presented with a 1-month history of fever followed by abdominal distension, constipation and bilious vomiting for 2 days. The clinical impression was of intestinal obstruction. At exploratory laparotomy, there was an ileal perforation secondary to tuberculosis. There are many case reports of tubercular ileal perforation in adults but in children it is very rare.

Primary tuberculosis of the appendix in a young male patient: report of a case.

A 23-year-old man without a history of tuberculosis presented with right lower abdominal pain and a fever. An increased inflammatory response was found, and abdominal computed tomography showed a diffuse enlargement and wall thickening in the appendix. An ileocecal abscess and perforating appendicitis were suspected. Therefore, an emergency operation was performed. The surgery revealed a diffuse enlargement with adhesion to the retroperitoneum, which was suspected to be a neoplastic lesion of the appendix, thus an ileocecal resection including the appendix was performed. A histopathological examination revealed a number of epithelioid granulomas having Langerhans giant cells with caseous necrosis in the appendix, in addition to many granulomas without caseous necrosis in the regional lymph nodes. No tubercle bacilli were detected by Ziehl-Neelsen staining. Further examination revealed no tubercular lesions in other organs, thus leading to the diagnosis of primary tuberculosis of the appendix. This is an extremely rare disease reported in Japan.

Abdominal tuberculosis in surgical practice in northern Nigeria.

BACKGROUND: Abdominal tuberculosis is a common complication of pulmonary tuberculosis. With the rising incidence of HIV, tuberculosis has become a major public health problem particularly in developing countries. METHODS: This is a retrospective study involving patients whose surgical specimens were processed at the central histopathology laboratory of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria--Nigeria, between January 1975 to December 2006. RESULTS: There were 68 males and 49 females, aged 12-70 years (mean 28.6 yrs 11 yrs). While paroxysmal dry cough was present in about 20 patients, abdominal pain and distension were very common. Concomitant pulmonary tuberculosis was confirmed in 15 patients (14%). The findings at Surgery in 66 patients are presented in fig. 2. Multiple deposits on the peritoneum and omentum were the commonest findings (48.7% and 26.2%) respectively CONCLUSION: Abdominal tuberculosis is not uncommon and there is need to establish an early less invasive diagnostic protocol.

Spectrum of clinical presentation and surgical management of intestinal tuberculosis at tertiary care hospital.

BACKGROUND: Tuberculosis can involve gastrointestinal tract anywhere from mouth to anus, the peritoneum and pancreatobiliary system. It has varied clinical presentations sometimes mimicking other common abdominal diseases. Tuberculosis continues to be a major problem especially in developing countries, being responsible for 7-10 million new cases and 6 per cent of deaths worldwide annually. Objective was to assess and evaluate various clinical presentations and management of intestinal tuberculosis at Liaquat University Hospital, Jamshoro/Hyderabad. METHODS: This 3-year descriptive study was conducted on patients with diagnosed intestinal tuberculosis (by histopathology) in Surgical Unit-I, from January 2006 to December 2008. Detailed history and clinical examination was performed in all the cases. Investigations like Blood CP and ESR, Urea, RBS Electrolytes, Serum A/G Ratio, Ultrasound abdomen, X-Ray chest and abdomen were carried out in all the cases while barium meal, follow through and CT Scan abdomen were performed in selected cases. Preoperative assessment of anatomical site and variety of lesions were also noted. RESULTS: A total of 60 patients with diagnosis of intestinal tuberculosis were admitted and operated. Diagnosis was confirmed by histopathology. Among these, 28 (46.7%) were male, and 32 (54.1%) were female. Variable clinical presentations were seen. Majority of patients (46, 76.7%) had abdominal pain, 26 (43.3%) had vomiting; abdominal distension was seen in 22 (36.7%) cases, diarrhoea and constipation in 16 patients (26.7%) and abdominal mass in 14 patients (23.3%). Majority of patients had ulcerostenotic type of tuberculosis. Single stricture of ileum was seen in 15 (25%) while multiple strictures were seen in 13 (21.7%). Ileal perforation was seen in 6 (10%) patients. Weight loss was seen in 40 (66.7%) patients, fever 36 (60%), night sweats 30 (50%), anorexia in 30 (50%) and pulmonary tuberculosis in 18 (30%) patients. Resection and anastomosis was performed on 24 (40%) cases, right hemicolectomy on 22 (36.7%), stricturoplasty on 8 (13.3%), adhesionolysis on 4 (6.7%), and Ileostomy on 2 (3.3%) patients. CONCLUSION: Abdominal pain, vomiting, fever and weight loss are the commonest symptoms in abdominal tuberculosis. Single and multiple strictures in the ileum, and mass in the ileocaecal region were the commonest lesions. Definitive surgical procedure like resection and anastomosis, stricturoplasty and right hemicolectomy are the main surgical options.

Surgical management of tuberculous small bowel obstruction.

BACKGROUND: Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored. METHODS: Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months. RESULTS: Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%. CONCLUSION: Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery.