title: Spectrum of abdominal-tuberculosis in emergency surgery: 100 cases at a tertiary care Centre Dow University of Health Sciences and Civil Hospital Karachi, Pakistan.
abstract: The study highlights the spectrum of abdominal TB in emergency surgery and its outcome. A proforma based prospective cross sectional study was conducted from March 2008 - March 2014, at the Department of General Surgery, Dow University of Health Sciences & Civil Hospital Karachi, Pakistan. Total patients studied were hundred. Ninety percent patients presented through the emergency department. Mean age was 30 ± 7.29 years. Family history of TB was positive in 46 (46%) patients. Pulmonary TB was present in 22 (22%), and 52 (52%) - were already on Antitubercular Therapy-- Emergency exploratory laparotomy was performed in 85 (85%) patients with 61 (61%) having peritonitis. and 24 (24%) having acute intestinal obstruction. A total of 15 (15%) patients were kept on ATT under observation, Of these 7(7%) were diagnosed with Ileocaecal mass, 5 (5%) with enterocutaneous fistula, and 3(3%) had sub-acute intestinal obstruction. Ileum was the most common site for abdominal TB in 36(36%), followed by ileocaecal TB in 13 (13%) and jejunal TB in 12 (12%). Stoma and abdominal washout was the minimum procedure which was performed in 34 (34%) cases. Fourteen (14%) patients diagnosed with ileocaecal TB, received limited right hemi colectomy with two end stoma whereas 7(7%) patients were subjected to limited right hemi colectomy with primary anastomosis. Patients with multiple strictures and perforations were subjected to segmental resection with two end stoma. This was performed, in 12 (12%) cases and primary repair and anastomosis in 9 (9%). Only washouts and laparostomy was performed in 5 (5%) and adhenolysis in 4(4%) cases. Redo surgery was required in 44 (44%). The overall mortality was 18%. This study concludes that abdominal TB patients usually present late with complications in emergency surgery because of diagnostic delay, having a high morbidity and mortality.
authors.affiliation: Department of General Surgery, Dow University of Health Sciences and Civil Hospital Karachi, Pakistan.
authors.forename: Shahida Parveen
authors.initials: SP
authors.lastname: Afridi
authors.affiliation: Medical Student, Dow international Medical College, Karachi, Pakistan.
authors.forename: Rameez Ahmed
authors.initials: RA
authors.lastname: Siddiqui
authors.affiliation: Department of General Surgery, Dow University of Health Sciences and Civil Hospital Karachi, Pakistan.
authors.forename: Akram
authors.initials: A
authors.lastname: Rajput
authors.affiliation: Department of General Surgery, Dow University of Health Sciences and Civil Hospital Karachi, Pakistan.
authors.forename: Shams Nadeem
authors.initials: SN
authors.lastname: Alam
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011446:Prospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000401:mortality; D055815:Young Adult
keywords: Abdominal TB, Emergency, late presentation, management in emergency.
  