title: Tuberculous perforations of the small intestine.
abstract: The hospital records of 58 patients operated on for tuberculous perforations of the small intestines at our hospital between 1987 and 1996 were reviewed. Clinical features were non-specific in the majority of the patients. Pneumoperitoneum on abdominal radiographs was present in only 28 (48.3%) patients. Forty-five (77.6%) were operated on within 36 hours of perforation. Surgical management consisted of resection and end-to-end anastomosis (n = 45); oval excision of the perforation and transverse anastomosis reinforced with an omental patch (n = 7); ileo-transverse colostomy (n = 5); and peritoneal drainage only (n = 1). There were 17 deaths (29.3%). Adverse prognostic factors were operation beyond 36 hours (p < 0.01), multiple perforations (p < 0.001), and faecal fistula formation (p < 0.01). Mortality was least with early resection and end-to-end anastomosis of the perforated bowel segment. We conclude that a high index of suspicion is essential for early diagnosis and optimal treatment of patients with tuberculous intestinal perforations.
authors.affiliation: Department of General Surgery, Jawahar Lal Nehru Medical College and Hospital, Ajmer, India.
authors.forename: S
authors.initials: S
authors.lastname: Talwar
authors.forename: R
authors.initials: R
authors.lastname: Talwar
authors.forename: P
authors.initials: P
authors.lastname: Prasad
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007194:India; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors; D014385:Tuberculosis, Gastrointestinal / Q000150:complications*