Clinical Presentation and Surgical Management of Abdominal Tuberculosis at M.Y. Hospital, Indore

BACKGROUND Abdominal tuberculosis has been a common disease that poses challenge for the diagnosis of disease, as vague symptoms of the disease always lead to delay in diagnosis. This disease can be called as an imitator of other abdominal pathologies. A high index of doubt is necessary to make early and accurate diagnosis. Abdominal involvement can occur in body at various places like gastrointestinal tract, solid viscera, peritoneum and lymph nodes. Numerous investigations have to be used to help in making the accurate diagnosis of abdominal tuberculosis. Accurate diagnosis in early pathogenic stage and starting of antitubercular therapy and surgical treatment are important to prevent complications leading to morbidity and mortality of patients. Patients having long term symptoms are often weak debilitated, anaemic, malnourished, chronically ill and underweight which may be due to cachexia. METHODS This is a prospective observational study conducted from March 2016 to March 2018, in Mahatma Gandhi Medical College Associated M.Y. Hospital, among 47 patients with a diagnosis of abdominal tuberculosis confirmed histopathologically. RESULTS Maximum patients in our study belonged to 20 to 40 yrs. age group. 27% were males and 72 % were females. 8% patients were treated conservatively and 91 % patients were offered operative treatment. Majority of patients presented with symptoms of abdominal pain (85%), abdominal distension (85%), vomiting (74%), weight loss (74%), fever (17%), alteration in bowel habits (21%) and lump in abdomen (6%). Most common findings were of primary perforations (68%), adhesions (46%), plastered abdomen (34%), ileocecal mass and ileocecal junction perforation (6%). Ileal and jejunal strictures were minor findings. In majority of patients, ileostomy (83%) was performed as life saving measure, adhesiolysis was done in 68%, primary closure of perforation (25%), resection and anastomosis (8.5%). CONCLUSIONS Since the clinical presentations of abdominal tuberculosis are very non-specific and vague and the diagnostic criteria are limited, diagnosis has to be supported by additional tests and by retrospective analysis with reference to clinical patterns and underlying diseases. We also emphasize the importance of histopathological examination in establishing the diagnosis in poor resource settings.