A STUDY OF CLINICAL PRESENTATION AND MANAGEMENT OF ABDOMINAL TUBERCULOSIS IN A TERTIARY CARE HOSPITAL

BACKGROUND: Abdominal Tuberculosis remains a major health problem in the developing countries especially in Indian subcontinent. Abdominal tuberculosis is a disease which has no clear clinical features even after a complete range of investigations. Thus, a high index of clinical suspicion is required to establish a diagnosis. Tuberculosis of GI tract accounts for 50% of all gastrointestinal cases. MATERIAL AND METHOD: The study was conducted in the Department of Surgery, Chirayu Medical College and hospital Bhopal from January 2011 to August 2013 to assess the clinical presentation management and outcome of abdominal tuberculosis. All patients with clinical features suggestive of abdominal tuberculosis were included in the study. Records of the patients were retrieved and reviewed to measure parameters of age, gender, socio-economic status, mode of presentation, operative findings, hospital stay and complications. The diagnosis of abdominal tuberculosis was confirmed by histopathology. RESULTS: A total of 51 patients were included in the study. Out of these, 26 patients (62%) were male and 25 patients (38%) were female. 21 patients (41.17 %) presented with acute while 30 patients (58.82 %) presented with chronic onset of disease. Intestinal obstruction was seen in 11 (21.56%) patients and perforation peritonitis was present in 10(19.60%) patients. Subacute intestinal obstruction was seen in 23(45.09%) cases. 4 patients (7.8%) presented with mass in right iliac fossa. 27 patients (52.94%) were treated conservatively while rest of them 24 (47.0%) underwent laparotomy. Grossly ileum was involved in 17 cases (9perforation and 8 stricture). During hospital course, 15 (29.41%) patients had post operative wound infection, 2(3.92%) had burst abdomen and 1(1.90%) had faecal fistula. Histopathological confirmation of tuberculosis was done in 72.54 % of cases. All patients were prescribed anti tuberculosis drugs for 12 months duration. Mean hospital stay was16 +/- 14.67 days. CONCLUSION: Abdominal tuberculosis is a disease that is frequently overlooked, with consequent delay in treatment. As a treatable condition, abdominal TB should be considered early in the differential diagnosis of abdominal symptoms in our country. Failure to recognise this disease early may lead to increase morbidity and mortality, as many of the patients need surgical intervention and prolonged hospitalization in addition to chemotherapy with anti tuberculosis drugs.