Varied Clinical Presentations of Abdominal Tuberculosis Causing Bowl Obstruction

Authors

  • Fazli Akbar Saidu Group of Teaching Hospital, Swat, KP Pakistan.
  • Shabab Hussain KMU Institute of Medical Sciences/DHQ Hospital, Kohat, KP Pakistan.
  • Ibtisam Amir KMU Institute of Medical Sciences/DHQ Hospital, Kohat, KP Pakistan
  • Sikandar Khan KMU Institute of Medical Sciences/DHQ Hospital, Kohat, KP Pakistan
  • Muhammad Ijaz Khattak KMU Institute of Medical Sciences/DHQ Hospital, Kohat, KP Pakistan

DOI:

https://doi.org/10.52206/jsmc.2024.14.4.943

Abstract

Background: This study investigates the clinical presentations and surgical outcomes of abdominal Koch's disease, a common cause of intestinal obstruction, and the outcomes of surgical interventions.
Objective: To evaluate the clinical presentations, surgical outcomes, and postoperative progress in patients with abdominal tuberculosis causing intestinal obstruction.
Materials and Methods: A study of 50 patients diagnosed with abdominal TB at DHQ Teaching Hospital from 16 September 2021 to 16 September 2022 found that 80% were emergency cases, with a male-to-female ratio of 1:1.2, and a mean age of 24 years. The majority were Afghan nationals, with a majority coming from lower-middle socioeconomic backgrounds. Common symptoms included abdominal pain, distension, constipation, vomiting, weight loss, pallor, abdominal tenderness, and a mass in the abdomen. Laboratory findings included anemia, leukocytosis and raised ESR. Imaging findings showed distended small bowel loops and multiple air-fluid levels in 80% of cases, while 20% had evidence of coexisting pulmonary Koch's on chest X-rays.
Results: Abdominal Koch's is diagnosed 50% of the time, with 35% of confirmed cases having positive clinical findings. Common lesions included strictures, ileocecal masses, and intestinal perforations. Surgical procedures varied, and patients received full antitubercular therapy postoperatively. Complications occurred in 30% of cases, and hospital mortality was 4%.
Conclusions: Abdominal tuberculosis, a major cause of intestinal obstruction, but it is mostly asymptomatic and commonly affecting lower-middle socioeconomic groups. Surgical intervention and antitubercular therapy often led to improvement, but postoperative complications and mortality persist.
Keywords: Abdominal tuberculosis, Intestinal obstruction, Mycobacterium tuberculosis.

References

World Health Organization. WHO Global Task Force on TB Impact Measurement: report of a subgroup meeting on methods used by WHO to estimate TB disease burden, 11-12 May 2022, Geneva, Switzerland. World Health Organization; 2022 Oct 10. DOI: http://doi.org/10.1002/9781119600687

Tahseen S, Khanzada FM, Baloch AQ, Abbas Q, Bhutto MM, Alizai AW, et al. Extrapulmonary tuberculosis in Pakistan-A nation-wide multicenter retrospective study. PLOS ONE. 2020;15(4): DOI: https://doi.org/10.1371/journal.pone.0232134

Yule A, Sills D, Smith S, Spiller R, Smyth AR. Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis. Expert Review of Respiratory Medicine. 2023 Jul 3;17(7):547-61. DOI: https://doi.org/10.1080/17476348.2023.2237790

Gupta P, Kumar S, Sharma V, Mandavdhare H, Dhaka N, Sinha SK, et al. Common and uncommon imaging features of abdominal tuberculosis. Journal of Medical Imaging and Radiation Oncology. 2019;63(3):329-39. DOI: https://doi.org/10.1111/1754-9485.12874

Narinyan W, Poladian N, Orujyan D, Gargaloyan A, Venketaraman V. Immunologic role of innate lymphoid cells against mycobacterial tuberculosis infection. Biomedicines. 2022 Nov 6;10(11):2828. DOI: https://doi.org/10.3390/biomedicines10112828

Behr MA, Edelstein PH, Ramakrishnan L. Rethinking the burden of latent tuberculosis to reprioritize research. Nat Microbiol. 2024;9(5):1157-1158. DOI: https://doi.org/10.1038/s41564-024-01683-0

Tahiri M, Goh KL, Abbas Z, Epstein D, Min-Hu C, Mulder CJ, et al. Digestive tract tuberculosis guideline. Journal of clinical gastroenterology. 2023 Aug 1;57(7):643-50. DOI: https://doi.org/10.1097/MCG.0000000000000225

Qureshi W. Diagnosis and Management Guide for Anorectal Disease: A Clinical Reference. CRC Press; 2024 Jun 1. DOI: https://doi.org/10.1201/9781003523826**​:contentReference[oaicite:0]{index=0}

Thomas AS, Schwartz M, Quigley E. Gastrointestinal lymphoma: the new mimic. BMJ Open Gastroenterology. 2019 Sep 1;6(1):e000320. DOI: https://doi.org/10.1136/bmjgast-2019-000320

Ahmad QA, Sarwar MZ, Fatimah N, Ahmed AS, Changaizi SH, Ayyaz M. Acute presentation and management of abdominal tuberculosis. J Coll Physicians Surg Pak. 2020 Feb 1;30(2):129-33. DOI: https://doi.org/10.29271/jcpsp.2020.02.129

Khan I, Ullah F, Khan M. Surgical Management of Abdominal Tuberculosis. J Postgrad Med Inst [Internet]. 2011;17(1). DOI: https://jpmi.org.pk/index.php/jpmi/article/view/796

Bali RS, Jain R, Zahoor Y, Mittal A. Abdominal tuberculosis: a surgical emergency. Int J Res Med Sci. 2017;5(9):3847-50. DOI: https://doi.org/10.18203/2320-6012.ijrms20173641

Ahmad QA, Sarwar MZ, Fatimah N, Ahmed AS, Changaizi SH, Ayyaz M. Acute presentation and management of abdominal tuberculosis. J Coll Physicians Surg Pak. 2020;30(2):129-33. DOI: https://doi.org/10.29271/jcpsp.2020.02.129

Goldstein E, Lipsitch M, Cevik M. On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the community. The Journal of infectious diseases. 2021 Feb 1;223(3):362-9. DOI: https://doi.org/10.1093/infdis/jiaa691

Kedia S, Ahuja V. Intestinal tuberculosis: an overview. Tuberculosis of the Gastrointestinal system. 2022 Feb 22:73-103. https://doi.org/10.1007/978-981-16-9053-2_6

Khim G, Em S, Mo S, Townell N. Liver abscess: diagnostic and management issues found in the low resource setting. British Medical Bulletin. 2019 Dec 11;132(1):45-52. DOI: http://doi.org/10.1093/bmb/ldz031

Kudu E, Danýþ F. Recognizing and addressing the challenges of gastrointestinal tuberculosis. World J Clin Cases. 2024 Jul 6;12(19):3648-3653. DOI: https://doi.org/10.12998/wjcc.v12.i19.3648 PMID: 38994296; PMCID: PMC11235435.

Abu-Zidan FM, Sheek-Hussein M. Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay. World Journal of Emergency Surgery. 2019 Jul 12;14(1):33. DOI: https://doi.org/10.1186/s13017-019-0252-3

Hussain SA, Ahmad SR, Mala TA. A thirty year study of clinico pathological profile of gastric cancer in Kashmir-A single institute based study. 2019 March 2(3);88-94 DOI: https://doi.org/10.36349/easms.2019.v02i03.001

Vanderpool DM, O'Leary JP. Primary tuberculous enteritis. Surg Gynecol Obstet. 1988 Aug;167(2):167-73. PMID: 3041634. DOI: https://doi.org/10.1007/BF02554572

Aston NO, De Costa AM. Abdominal tuberculosis. International Journal of Clinical Practice. 1990;44(2):58-63. DOI: https://doi.org/10.1111/j.1742-1241.1990.tb10736.x

Hardy MA, Yang C. How to Diagnose and Manage Acute Abdomen and Intra-Abdominal Infections in Low-and Middle-Income Countries. InGlobal Surgery: How to Work and Teach in Low-and Middle-Income Countries 2023 Jul 21 (pp. 317- 337). DOI: https://doi.org/10.1007/978-3-031-28127-3_27

Patterns AB. Abnormal Bowel Gas Patterns and Extraluminal Gas in Abdomen. Textbook of Gastrointestinal Radiology. 2021 Jun 3:13.

Roy-Chowdhuri S, Dacic S, Ghofrani M, Illei PB, Layfield LJ, Lee C, et al. Collection and handling of thoracic small biopsy and cytology specimens for ancillary studies: guideline from the college of American pathologists in collaboration with the American college of chest physicians, association for molecular pathology, American society of cytopathology, American thoracic society, pulmonary pathology society, papanicolaou society of cytopathology, society of interventional radiology, and society of thoracic radiology. Archives of pathology & laboratory medicine. 2020 Aug 1;144(8):933-58. DOI: https://doi.org/10.5858/arpa.2020-0119-CP

Buchanan, G. N., & Rotimi, O. (2010). Surgical techniques for colorectal cancer: A comprehensive guide. Annals of the Royal College of Surgeons of England, 92(2), 165170. DOI: https://doi.org/10.1308/003588410X12628812459129

Additional Files

Published

11-11-2024

How to Cite

1.
Fazli Akbar, Shabab Hussain, Ibtisam Amir, Sikandar Khan, Muhammad Ijaz Khattak. Varied Clinical Presentations of Abdominal Tuberculosis Causing Bowl Obstruction. J Saidu Med Coll Swat [Internet]. 2024 Nov. 11 [cited 2024 Dec. 5];14(4):393-9. Available from: http://jsmc.pk/index.php/jsmc/article/view/943

Most read articles by the same author(s)