Clinicopathological profile and surgical treatment of abdominal tuberculosis: a single centre experience in northwestern Tanzania

Abstract

BackgroundAbdominal tuberculosis continues to be a major public health problem worldwide and poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was conducted to describe the clinicopathological profile and outcome of surgical treatment of abdominal tuberculosis in our setting and compare with what is described in literature.MethodsA prospective descriptive study of patients who presented with abdominal tuberculosis was conducted at Bugando Medical Centre (BMC) in northwestern Tanzania from January 2006 to February 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0.ResultsOut of 256 patients enrolled in the study, males outnumbered females. The median age was 28 years (range = 16–68 years). The majority of patients (77.3%) had primary abdominal tuberculosis. A total of 127 (49.6%) patients presented with intestinal obstruction, 106 (41.4%) with peritonitis, 17 (6.6%) with abdominal masses and 6 (2.3%) patients with multiple fistulae in ano. Forty-eight (18.8%) patients were HIV positive. A total of 212 (82.8%) patients underwent surgical treatment for abdominal tuberculosis. Bands /adhesions (58.5%) were the most common operative findings. Ileo-caecal region was the most common bowel involved in 122 (57.5%) patients. Release of adhesions and bands was the most frequent surgical procedure performed in 58.5% of cases. Complication and mortality rates were 29.7% and 18.8% respectively. The overall median length of hospital stay was 32 days and was significantly longer in patients with complications (p < 0.001). Advanced age (age ≥ 65 years), co-morbid illness, late presentation, HIV positivity and CD4+ count < 200 cells/μl were statistically significantly associated with mortality (p < 0.0001). The follow up of patients were generally poor as only 37.5% of patients were available for follow up at twelve months after discharge.ConclusionAbdominal tuberculosis constitutes a major public health problem in our environment and presents a diagnostic challenge requiring a high index of clinical suspicion. Early diagnosis, early anti-tuberculous therapy and surgical treatment of the associated complications are essential for survival.

Surgical interventions in abdominal tuberculosis: a clinico-pathological study

“…Most of the other studies have also shown similar observations. [8][9][10] In present study cases with primary abdominal tuberculosis (68%) were more common than patient with abdominal tuberculosis associated with pulmonary TB on family history of pulmonary TB (32%).…”

“…Male:female ratio was (1.4:1), in study by Urabinohatti KA ratio was 1.8:1, Awasthi S also reported ratio of 1.4:1, and male preponderance was the finding in most of the studies. [10][11][12] However in some studies Sankpal J et al Male:female ratio was 1:1.6, Hossain SM reported ratio of 5:8.…”

“…Chalya PL et al reported that (93.8%) cases had abdominal pain when first seen, the other studies have also shown abdominal pain as the most common symptoms. 9,10,16 Abdominal tenderness was the most common sign seen in 84% cases. Shaikh MS also have abdominal tenderness as the most common sign seen in 91%.…”

“…15 Awasthi S and Chalya PL observed that 22.6% and 29% respectively were associated with pulmonary tuberculosis. 10,12 Abdominal pain was the most common symptoms seen in 86% cases. Chalya PL et al reported that (93.8%) cases had abdominal pain when first seen, the other studies have also shown abdominal pain as the most common symptoms.…”

“…However, Rao V observed segmental resection as the most common performed surgical. 9,10,15,17 Wound infection was the most common complication seen in 34% cases. Charokar K, Chalya PL have also shown wound infection as most common post-operative complication seen in 29% and 37% respectively.…”