title: Tubercular bowel perforation: what to do?
abstract: BACKGROUND
  The incidence of abdominal tuberculosis (TB) is increasing in western and developed countries. This pathology has several complications, including free intestinal perforation. The aim of this study was to analytically summarize all the pertinent literature discussing the various treatments for TB-related perforations.
  
  
  METHODS
  We reviewed the patient database of the Emergency Surgery Department of the Bologna University Hospital, checking the last 13 years. A retrospective review was conducted of all reported cases of intestinal perforation due to intestinal TB published through 3 March 2009.
  
  
  RESULTS
  119 cases of abdominal TB presenting with intestinal perforation were published. There are no standardized guidelines regarding the surgical treatment. Of the 119 reported cases, 40 (33.6%) were treated with resection and anastomosis, 17 (14.2%) with direct sutures, 4 (3.3%) with a simple drain, and in 57, the treatment was not reported.
  
  
  CONCLUSIONS
  No clinical evidence has been available for analysis to discern the optimal surgical strategy for treating intestinal perforations induced by TB. The direct closure of the perforation typically correlates with poor morbidity and mortality results. The better treatment seems to be the surgical resection of the perforated part with anastomosis. However, pharmacological therapy remains the essential pillar of treatment.
authors.affiliation: Department of Surgery, Bologna University, St. Orsola Hospital, Bologna, Italy. fedecocco@iol.it
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Daniel
authors.initials: D
authors.lastname: Lazzareschi
authors.forename: Lorenza
authors.initials: L
authors.lastname: Puviani
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology