BACKGROUNDTuberculous lymphadenitis is the commonest cause of lymphadenopathy in developing countries. This study was conducted to analyse the clinical presentation, complications and recurrences in patients presenting with tuberculous lymphadenitis. MATERIALS AND METHODSThis descriptive study is based on the observation of two groups of patients: a retrospective and prospective group of patients attending the outpatient department and the patients admitted in Christian Medical College & Hospital, Ludhiana. The retrospective group included all patients over 12 years of age who had presented with lymphadenopathy and were diagnosed as tuberculous lymphadenitis and their medical records reviewed. The prospective group were clinically examined, haematological and histopathological investigations were carried out. They were followed up for assessment of complications. RESULTSA total number of 171 cases were qualified to be included in this study. Patients with matted lymph nodes constituted 53.8% and discrete lymph nodes constituted 46.2%. Lymph nodes with a firm consistency constituted a significant proportion of 74.9% compared with lymph nodes with soft and hard consistencies constituting 20.5% and 4.7% respectively. Cervical node involvement was there in 70.7% of patients. The mean lymph node size was 6.9 cm with a variation between 0.5-20 cm. Nearly 38% of them had positive reaction for PPD. Chest X-ray findings were normal in 57.9% of patients. Nearly 50% of patients had fever as the chief complaint.

A 19-year-old naval cadet presented with abdominal pain of 03 hours duration. Pain was of sudden onset confined to the periumbilical region. Pain was colicky in nature without relieving or aggravating factors. There was no relevant past history. The individual was a vegetarian. On examination, the patient was afebrile, and vitals were stable. Abdominal examination revealed tenderness over the periumbilical region. Provisional diagnosis of Acute Appendicitis/ Intestinal Colic was made, and the patient was commenced on parenteral antibiotics and intravenous fluids. Thereafter, the patient had an episode of severe abdominal pain shifting to the left hypochondrium and lumbar region. There was no associated vomiting. Stool was present on rectal examination. Blood and Urine values were grossly normal (TLC-7700, DLC: N71, L23, E02, M04: Amylase-34). NCCT Abdomen revealed-(i) Dilated centrally located small bowel loops, (ii) Large bowel displaced and compressed laterally, (iii) Rectum filled with air and faecal matter, (iv) Sudden transition of dilated small bowel loops in left lower abdomen with collapsed small bowel loops distal to the transition zone, (v) Minimal free fluid: no other acute signs. (Figure 1) Phytobezoars occur in all age groups with absent physical findings. Small bowel Phytobezoars usually have an acute presentation with features of intestinal obstruction or perforation. (1) Radiological studies for detection of phytobezoars include Abdominal X-rays, Barium studies and USG and CT scans. (2) Currently, abdominal CT scans is the diagnostic modality of choice for detecting phytobezoars in the small bowel, as it can concurrently detects additional bezoars within the gastrointestinal tract. Surgery is the management of choice in small bowel phytobezoars. Definitive management consists of Exploratory Laparotomy with milking of contents into the caecum or performing an enterotomy with retrieval of contents. [3] During surgery it is mandatory to carry out a thorough exploration of the small intestine and colon to avoid recurrence of obstruction due to retained bezoar. Additionally, laparoscopic enterotomy is an effective less invasive treatment as it is associated with shorter hospital stay, early return of GI function and recovery time. (3) Gastrointestinal bezoar obstruction is uncommon and accounts for only 0.4-4% of all intestinal obstruction cases. In this paper, we present a rare case of intestinal phytobezoar.