title: Diagnosis and treatment strategies of tuberculous intestinal perforations:  a case series.
abstract: Gastrointestinal tuberculosis (TB) may result in intestinal obstruction and perforation, even after antituberculous therapy has been initiated. Despite surgical intervention tuberculous perforation has a high complication and mortality rate, and it is difficult to predict the subgroup of patients with abdominal TB who progress to perforation. In this study, we retrospectively investigated the clinical features that may predict disease progression in patients in our institution who presented abdominal TB over a 5-year period between January 2006 and August 2011, as well as describe an unreported method of managing tuberculous intestinal perforations when resection with end-to-end anastomosis is unfeasible. Six out of 91 patients (6.6%) with abdominal TB developed perforations. Factors linked with increased complications and mortality were age, comorbidities, multiple perforations and length of time between onset of abdominal symptoms and perforation. Four patients (66.7%) had long histories of abdominal symptoms before perforation. Three patients were receiving or had completed antituberculous therapy before developing perforation. Five patients were managed surgically, two underwent laparostomy as both primary closure and end-to-end anastomosis were deemed too risky. Mortality following perforation was 17%. Patients with prolonged abdominal symptoms, even after antituberculous therapy, should raise suspicion for subacute intestinal obstruction. This should be recognized early and surgical intervention considered in order to prevent mortality secondary to perforation. Laparostomy may be an alternative when resection and end-to-end anastomosis is not possible.
authors.affiliation: Faculty of Medicine, Imperial College London, London, UK. ming.lee06@imperial.ac.uk
authors.forename: Ming J
authors.initials: MJ
authors.lastname: Lee
authors.forename: Fiona V
authors.initials: FV
authors.lastname: Cresswell
authors.forename: Laurence
authors.initials: L
authors.lastname: John
authors.forename: Robert N
authors.initials: RN
authors.lastname: Davidson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000075202:Contraindications; D018450:Disease Progression; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000379:methods; D010529:Peritoneal Cavity / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult