Abstract

Aim: To establish that laparoscopy is important modality of diagnosis and treatment in all cases of abdominal tuberculosis and can be life saving in certain grave and complicated cases.

Design: Prospective study done at department of surgery, Darbhanga Medical College and Hospital, Bihar from 2011- 2015. Cases were analyzed in terms of demography, clinical features, investigations, operative treatment, and outcome.

Materials and Methods:  80 patients with abdominal tuberculosis having age between 10yrs to 80 yrs age were included in the study. Among these there were 55 %( n=44) male patients and 45% (n=36) female patients with abdominal tuberculosis.

All the patients were subjected to detailed history and clinical examination followed by investigations and diagnostic laparoscopy.

Diagnostic laparoscopy was done to confirm the diagnosis. The following features seen by laparoscopy supports the diagnosis of abdominal tuberculosis:

• Ascitic fluid in Peritoneal Cavity
• Adhesions & Bands in Peritoneum
• Tubercles
• Stricture
• Enlargement of mesenteric lymph node

Histopathology: biopsy of lymph nodes was sent for histopathological examination for final confirmation of diagnosis of tuberculosis.

Management: The cases were divided into two groups:

1. Conservative: this group consisted of cases presenting with features of subacute obstruction .This group was managed by antitubercular drug treatment along with advise on diet and nutrition.
2. Operative: this group consisted of patients presenting with features of acute obstruction .This group was subjected to laparoscopy and /or laparotomy and the following operative procedures were done:

• Conservative ileo caecal resection
• Ileotransverse anastomosis
• Stricturoplasty
• Resection and anastomosis
• Simple closure of perforation
• Right hemicolectomy
• Laparotomy and biopsy

Follow up: After recovery patients were discharged with advise on use of drugs and report for checkup after 1 month, then 3 months, then 6 months and 1 year .In follow up subjective symptoms like abdominal distension, constipation, diarrhea, anorexia and weakness were regularly monitored. Objective improvement by accessing gain in body weight, hemoglobin percent and fall in E.S.R. was considered.

Results

• 5% cases (n=10) improved on conservative management with antitubercular treatment along with hydration, correction of electrolyte imbalance, vitamin supplementation and nutritional support.
• Remaining 87.5% cases (n=70) had to undergo surgical intervention in form of laparoscopy or laparotomy for definitive treatment.
• Limited right hemicolectomy (ileo caecal resection) was the most common surgical procedure and done in 42.5% of cases (n=34).
• Laparoscopic adhesiolysis was done in 25% of cases (n=20) presenting with adhesions and abdominal cocoon.
• Stricturoplasty was done in 12.5% cases (n=10)
• Resection and anastomosis was done in 7.5% cases (n=6) presenting with perforation and multiple adjacent strictures.

Conclusions: Laparoscopy is invaluable tool aiding in early diagnosis of abdominal and intestinal tuberculosis. In acute cases, surgical management is life saving. Limited right hemi-colectomy (ileo caecal resection) is the most commonly performed procedure with good results.

Keywords: Abdominal tuberculosis, laparoscopy, Intestinal stricture, Bowel perforation, Resection anastomosis, hemicolectomy.

Keywords:  laparoscopy, Laparotomy, Abdominal tuberculosis, Intestinal stricture, Bowel perforation, Resection anastomosis, right hemicolectomy.

Dr Shamim Khurrum Azmi

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