Surgical Management of Patients With GI Tuberculosis

Abstract

BACKGROUND: The Philippines ranks 10th in tuberculosis prevalence worldwide. Aside from pulmonary tuberculosis, GI tuberculosis remains an important cause of morbidity and mortality, particularly in endemic areas. OBJECTIVE: This study aimed to describe the clinicopathologic profile and surgical outcomes of patients with GI tuberculosis. DESIGN: Retrospective descriptive study. SETTING: Department of Surgery at the Philippine General Hospital, Manila, Philippines. PATIENTS: This study included all newly diagnosed cases of GI tuberculosis from January 1, 2009, to December 31, 2019. MAIN OUTCOME MEASURES: Clinical response to surgery. RESULTS: A total of 241 confirmed new cases were managed during an 11-year period. Of these, 208 patients (86.30%) underwent outright surgery, whereas the remaining patients (13.69%) received antituberculous therapy. Fifteen medically managed patients eventually required surgery, bringing the total surgically managed patients to 223. The patients’ age ranged from 19 to 72 years, with a 1.9:1 male to female ratio. The most common complaint was abdominal pain. Intestinal obstruction was the most common indication for surgery. A right hemicolectomy was the most often performed procedure, with the ileocecal area as the most frequently involved segment. The most common histopathologic findings were epithelioid granuloma and caseation necrosis. Postoperative length of stay ranged from 0 to 59 days (mean, 7 days). Morbidity rate was 5.38% and mortality rate was 3.14%. Four deaths were operative and resulted from septic shock because of hollow viscus perforation. LIMITATIONS: This study was limited to histopathologic basis for diagnosis. CONCLUSION: The recommended initial therapy for all forms of extrapulmonary tuberculosis is a 6-month regimen of antituberculous therapy unless the organisms are known or suspected to be resistant to first-line drugs. Surgery is reserved for complications of intra-abdominal tuberculosis: obstruction, perforation, or severe bleeding. Timely surgical intervention, coupled with medical management led to the best outcomes for these patients. See Video Abstract at http://links.lww.com/DCR/C56. MANEJO QUIRÚRGICO DE PACIENTES CON TUBERCULOSIS GASTROINTESTINAL ANTECEDENTES: Las Filipinas ocupa el décimo lugar en prevalencia de tuberculosis en todo el mundo. Aparte de la tuberculosis pulmonar, la tuberculosis gastrointestinal sigue siendo una causa importante de morbilidad y mortalidad, especialmente en las zonas endémicas. OBJETIVO: Este estudio tuvo como objetivo describir el perfil clinicopatológico y los resultados quirúrgicos de pacientes con tuberculosis gastrointestinal. DISEÑO: Estudio descriptivo retrospectivo. AJUSTE: Departamento de Cirugía del Hospital General de Filipinas, Manila, Filipinas. PACIENTES: Todos los casos de tuberculosis gastrointestinal recién diagnosticados desde el 1 de Enero del 2009 hasta el 31 de Diciembre del 2019. MEDIDAS DE RESULTADO PRINCIPAL: Respuesta clínica a la cirugía. RESULTADOS: Se manejaron un total de 24...

Acute intestinal obstruction: What if it is instead colonic tuberculosis? What diagnostic and management dilemmas are there?

“…Surgery should be carried out in the management of complicated forms including intestinal obstruction (15–60 %), fistula (25 %), perforation (15 %) and hemorrhage. Perforation increases rate of mortality and in this situation, it ranges from 30 to 40 % [ 23 ].…”

Evidence-based approach to diagnosis and management of abdominal tuberculosis

“…Apart from through-the-scope (TTS) balloon dilatation, for which data is available, there is no data for additional modalities, including endoscopic stricturotomy, in GITB. Certain patients may require surgery, especially if they are suffering from unrelenting intestinal obstruction, recurrent abdominal pain or episodes of obstruction, massive gastrointestinal bleeding or perforation peritonitis [63,64].…”