title: Surgical management of obstructive gastroduodenal tuberculosis.
abstract: BACKGROUND
  Gastroduodenal tuberculosis is a rare but potentially curable condition. The aim of the present study was to evaluate the clinical presentation, pre-operative status, management and outcome in patients with histologically proven diagnosis of gastroduodenal obstruction due to tuberculosis.
  
  
  METHODS
  We retrospectively reviewed the records of 17 patients managed surgically for gastroduodenal obstruction due to tuberculosis.
  
  
  RESULTS
  The site of obstruction was the pyloroduodenal canal in 53% of patients, second part of the duodenum in 24%, third part of the duodenum in 12% and duodenjojejunal flexure in 12%. The obstruction was caused by fibrotic stricture formation in 59% of patients and extrinsic compression by a lymph nodal mass in 41%. Endoscopic biopsy was diagnostic in only 29% of the patients in whom it was performed. Overall, a pre-operative diagnosis of gastroduodenal tuberculosis was suspected in only 35% of patients. All the patients underwent surgical drainage procedures and the diagnosis was confirmed by histopathological examination of biopsies taken at the time of laparotomy.
  
  
  CONCLUSIONS
  In view of its rarity and non-specific findings on clinical, radiological and endoscopic evaluation, tuberculosis as a cause of gastroduodenal obstruction is seldom diagnosed pre-operatively. Hence, a high index of suspicion is required in young patients residing in endemic areas. Surgical intervention helps not only in relieving obstruction but also in confirming the diagnosis.
authors.affiliation: Department of Gastrointestinal Surgery, G.B. Pant Hospital, University of Delhi, New Delhi 110002, India.
authors.forename: Sanjay Singh
authors.initials: SS
authors.lastname: Negi
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Sachdev
authors.forename: Adarsh
authors.initials: A
authors.lastname: Chaudhary
authors.forename: Nirmal
authors.initials: N
authors.lastname: Kumar
authors.forename: Ranjana
authors.initials: R
authors.lastname: Gondal
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004378:Duodenal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000601:surgery*