Surgery for Abdominal Tuberculosis in the Present Era: Experience from a Tertiary-Care Center

Singh, Harjeet; Krishnamurthy, Gautham; Rajendran, Jayapal; Sharma, Vishal; Mandavdhare, Harshal; Kumar, Hemanth; Yadav, Thakur Deen; Vasishta, Rakesh Kumar; Singh, Rajinder

doi:10.1089/sur.2018.077

Cited by 18 publications

(20 citation statements)

References 17 publications

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“…The principle form of surgery carried out was ileocecal resection, right hemicolectomy and small bowel resection. [ 124 ] In other studies 86% (182/212) to 91% (10/11) of the surgeries in abdominal TB were done in an emergency and only 9% (1/11) to 14% (30/212) were elective. [ 35 38 ] The reasons for surgery included adhesions in 27% (6/22) to 59% (124/212), strictures 31% (11/35) to 51% (11/22), perforation 18% (38/212) to 72% (26/35), peritonitis 23% (8/35) to 36% (76/212), ileocecal mass 7% (14/212) to 14% (3/22), and failed ATT in 9% (1/11) to 14% (30/212).…”

Section: Treatmentmentioning

confidence: 99%

Gastrointestinal tuberculosis

Alzanbagi¹,

Shariff²

2021

Saudi Journal of Gastroenterology

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Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.

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Section: Treatmentmentioning

confidence: 99%

Gastrointestinal tuberculosis

Alzanbagi¹,

Shariff²

2021

Saudi Journal of Gastroenterology

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“…Ischemic enteritis, radiation enteritis, intestinal Crӧhn's, immunoglobulin G4-related disease, infection especially tuberculosis and neoplastic causes are the more common diagnosis in intestinal strictures. [1][2][3][4]23 However, one must understand that NMVH is a morphological diagnosis, which can be primary or secondary. Consequently, a diagnosis of NMVH does not preclude the possibility of a primary diagnosis like vasculitis, vasculopathy, inflammatory, or ischemic diseases.…”

Section: Discussionmentioning

confidence: 99%

“…It is caused by various underlying pathological factors like tuberculosis, Crӧhn's disease, neoplastic conditions, and radiation to name a few. [1][2][3][4] Neuromuscular and vascular hamartoma (NMVH) and diaphragm disease (DD) are relatively uncommon causes of intestinal stricture leading to intestinal obstruction.…”

Section: Introductionmentioning

confidence: 99%

Histopathologic Spectrum of Neuromuscular and Vascular Hamartoma With Special Reference to the Vasculopathic Phenomenon

et al. 2019

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Neuromuscular and vascular hamartoma (NMVH) is an unusual lesion presenting as intestinal obstruction by stricture formation. It is characterized by a hamartomatous mass comprising haphazardly arranged mesenchymal tissue native to the intestinal mucosa and submucosa. We aimed to characterize the clinicohistopathological spectrum of NMVH in adult subjects with a search for an etiological clue. We reviewed 84 resected specimens (adult cases) of intestinal obstruction in our institute and diagnosed 4 cases with NMVH. A panel of special stains (Masson trichrome, Verhoeff-van-Gieson, and periodic acid–Schiff) and immunohistochemistry (smooth muscle actin, S100, Bcl2, CD34, vimentin, desmin, CD117, and CD3) were performed in all cases. All cases of NMVH showed characteristic hamartomatous mounds comprising haphazardly arranged smooth muscle, nerves, ganglia, vessels, and collagen with overlying mucosal ulceration. Adjacent bowel showed submucosal fibrosis, muscularis mucosae thickening, and duplication along with vasculopathy. A typical vasculopathy (“vessel-in-vessel” appearance) was seen in the submucosal and/or subserosal veins. Besides, different other forms of vasculopathic changes like obliterative venopathy and concentric myohypertrophy were also seen. One case had vasculitis and the patient died despite successful surgery. One other case was associated with lymphocytic ganglioneuronitis and granulomatous etiology. We conclude that NMVH can be multifactorial in origin although ischemia resulting from vasculopathy appears to be directly causative. The characteristic vasculopathy in the submucosal location may aid in the diagnosis of NMVH in small biopsy samples.

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“…In spite of this generally accepted approach, minilaparotomy surgery is beneficial for some patients when we agree with our internal medicine clinics and this is the most common method in our series. It is accepted that 20% of patients with abdominal tuberculosis will have to undergo emergency surgery at some time in their lives [5] .…”

Section: Discussionmentioning

confidence: 99%

Primary and secondary abdominal tuberculosis as a great mimicker of many diseases in general surgery

2019

Haydarpasa Numune Med J

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Introduction: Nonspecific characteristics of abdominal tuberculosis (AT) help the disease to mimic a grade scale of intraperitoneal conditions from cancer to inflammation. A significant burden arises from the diagnostic challenge also contributes to the deterioration of the conditions, which necessitates a higher than normal level of suspicion. Methods: Patients with AT who had no evidence of tuberculosis on lung imaging or anamnesis were evaluated in the primary AT (Group 1) group. Patients with AT who were found to have tuberculosis in lung imaging tests, anamnesis or another organ or in another part of the body and who had AT were examined in the secondary AT (Group 2) group. These two groups were compared with various parameters. Results: Of the 14 patients, who formed the primary AT group, eight of them were female, and six of them were male. Of the 36 patients who formed the secondary AT group, 18 were female, and 18 were male. The mean age of the primary AT group was significantly lower than the secondary AT group (p=0.027). The mean hematocrit value of the primary AT group was significantly lower than the secondary AT group (p=0.015). It was observed that the distribution of the presence of ascites in CT in the secondary AT group was significantly higher than the primary AT group (p=0.019). The presence of fever in the primary AT group was observed to be significantly higher than the secondary AT group (p=0.046). Presence of cough in secondary AT group was found to be statistically significantly higher (p=0.021). Discussion and Conclusion: Aging of all populations worldwide, drug resistance, increased number of immigrants and immunocompromised patients, all resulted in a minor pandemic of AT in all geographies. Although primary and secondary AT seem to share many similar characteristics, they also have statistically significant differences from each other.

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Surgery for Abdominal Tuberculosis in the Present Era: Experience from a Tertiary-Care Center

Abstract: Surgical intervention is warranted in a subset of patients with abdominal tuberculosis and may be required in patients with recurrent intestinal obstruction or pain, intestinal perforation, or gastrointestinal bleeding.

Cited by 18 publications

References 17 publications

Gastrointestinal tuberculosis

Gastrointestinal tuberculosis

Histopathologic Spectrum of Neuromuscular and Vascular Hamartoma With Special Reference to the Vasculopathic Phenomenon

Primary and secondary abdominal tuberculosis as a great mimicker of many diseases in general surgery

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