Tariq Mahmood Rehan, Ihshan, Qazi Masroor Ali, Muhammad Sajid.
Return of the infectious ghost: tuberculosis.
Pak J Surg Jan ;22(4):215-8.

Objective: To find out the incidence of Abdominal Tuberculosis, its presentation, morbidity and mortality. Design & Duration: Prospective, descriptive study from Jan. 2001 to Dec. 2004. Setting: Surgical Unit III, Bahawal Victoria Hospital, Bahawalpur. Patients: All patients who presented with abdominal tuberculosis and were confirmed on histopathology. Patients with tuberculosis at other sites were excluded. Methodology: The data of the patients was collected and analyzed. Results: A total of 123 patients were inducted in the study. Amongst them 65 (52.85%) were male and 58 (47.15%) female, with most (92) patients between 20-40 years of age. Eighty four patients presented with acute abdominal symptoms; 23 had intestinal obstruction, 49 peritonitis, while 12 patients had mesenteric lymph node abscess or primary tuberculous peritonitis with military tuberculosis. The remaining 39 patients presented with chronic symptoms i.e. subacute intestinal obstruction / abdominal masses. At laparotomy 31 cases had ascites and 49 cases gut perfora- tions (mostly in the ileum), whereas 55 cases had strictures and adhesions formation. Lymphadenopathy was seen in 24 and abscesses in 13 cases. Five patients had masses in the ileocaecal region and two at other places, whereas two patients had hepatomegaly. In the majority (63) of patients an ileostomy was made either alone or with resection and anastomosis, strictureplasty or closure of perforation. In 17 cases only biopsy and in 13 right hemicolectomy was carried out. In the post-operative period high morbidity was noted in the form of wound infection in 54 (43.9%) cases, while intra-abdominal abscesses were found in seven and severe sepsis in eight patients. Faecal fistula due to anastomotic leakage was noted in five cases in which redo surgery was done in the form of ileostomy. Jaundice was seen in six patients, two amongst them had tuberculous liver masses. As far as mortality was concerned, four (3.25%) patients died in this study. Conclusion: Tuberculosis has come back very strongly and with more involvement of extra-pulmonary sites.

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