Cases Of Abdominal Tuberculosis Research Articles

COMPARATIVE STUDY OF EFFICACY OF ONDANSETRON VERSUS ONDANSETRON AND DEXAMETHASONE COMBINATION IN PREVENTING POSTOPERATIVE NAUSEAAND VOMITING AFTER LAPAROSCOPIC CHOLECYSTECTOMY

This study aims to compare the efcacy of Ondansetron alone versus Combination of Ondansetron and Dexamethasone in terms of preventing Postoperative Nausea and Vomiting, Pain and duration of hospital stay. Material And Methods:Aprospective interventional randomized control study was conducted in the Department of General Surgery, SGT Medical College Hospital and Research Institute, Gurgaon, Haryana. The randomization was done according to the standard methods to allocate the patients to either Group A(total 30 patients) receiving Ondansetron 4mg + 2ml normal saline (total of 3ml) intravenous (IV), 1 minute before induction of anesthesia and Group B (total 30 patients) receiving Ondansetron 4mg and Dexamethasone 8mg (total of 3ml) IV, 1 minute before induction of anesthesia. Adequate sample size of 60 patient fullling inclusion and exclusion criteria mentioned are studied. The data was collected in a pre-designed study proforma and statistical analysis was performed. The treatment and drug efcacy were compared between two groups in terms of postoperative nausea and vomiting, pain and duration of hospital stay. RESULT: The total incidence of post-op nausea and vomiting following administration of Dexamethasone along with ondansetron was 1 patient (3.3 %) whereas 15 patients (50%) in group where dexamethasone was not administered which is signicant. The 1 patient of Group B was a case of abdominal tuberculosis with brosis of stomach serosa. Marked relief in post-op pain and shorter hospital stay was observed in group B which was administered steroid. Conclusion: From this study, we can conclude that administration of steroid like dexamethasone along with Ondansetron has signicant role in prevention of post-op nausea and vomiting, pain and gives shorter hospital stay, making it a necessary step to be followed when performing Day-care Laparoscopic Cholecystectomy.

Abdominal Tuberculosis Presenting as Anemia Refractory to Standard Therapy in an Elderly Male

Abstract India bears a significant proportion of tuberculosis cases, accounting for approximately 28% of the global burden. Among the reported global cases, around 16% constitute extrapulmonary tuberculosis (EPTB). EPTB diagnosis and treatment are usually challenging. The diagnosis frequently requires the application of contemporary methods, such as acquiring extrapulmonary samples and utilizing advanced diagnostic tools that involve immunological and molecular techniques. Here, we present a case of an elderly male who presented with constitutional symptoms and severe anemia which was refractory to standard hematinic and transfusion therapy. The patient was diagnosed to be a case of abdominal tuberculosis and improved with antitubercular therapy.

Tomographic findings in peritoneal tuberculosis: case report

Introduction: Peritoneal tuberculosis (TBCP) is a diagnostic challenge because the clinical, radiological and laboratory findings are nonspecific and can be confused with other pathologies. Presentation of the clinical case: Patient who consulted for intense abdominal pain, fever and diarrhea. TBCP was suggested based on abdominal CT findings, which was confirmed by histopathological analysis of parietal peritoneum biopsy and granulomatous lesions of the small intestine mesentery. The patient received an antituberculous regimen and was discharged from the hospital. Discussion and literature review: CPTB represents between 25-50% of abdominal tuberculosis cases and 0.1-0.7% of all tuberculosis cases, its clinical presentation includes ascites, abdominal pain, fever and diarrhea, making it indistinguishable from tuberculosis. Bacterial peritonitis and other chronic abdominal conditions. Conclusions: The diagnosis of TBCP is a challenge, however, the tomographic findings provide information that increases its suspicion and helps to avoid treatment delay and complications.

Costochondral gout

We present a case of a 37-year-old Caucasian woman with abdominal distension and loss of weight. She was initially presumed to be a case of ovarian malignancy due to an elevated serum cancer antigen 125 (CA 125) level and imaging of abdomen and pelvis that showed ascites and bulky ovaries. However, histological examination of biopsy later revealed it to be a case of abdominal tuberculosis (AbT). Ascitic fluid was also found to be positive for <i>Mycobacterium tuberculosis</i> by whole genome sequencing. The patient was started on antituberculosis treatment following which she showed a significant improvement in her symptoms.

Abdominal tuberculosis

ABSTRACT. The problem of detecting and diagnosing abdominal tuberculosis (TB) remains difficult. Recently in Ukraine there has been an increase in extrapulmonary TB, including abdominal TB. In modern conditions, this localization of TB is a manifestation of a generalized process in HIV-infected people. The most commonly diagnosed lesions of the lymphatic system and the peritoneum. The liver and spleen in abdominal TB is affected in every third case (32.3 %). In most patients, TB of the abdominal organs develops as a result of lymph-hematogenous dissemination from the primary focus, progresses through contact from the mesenteric lymph nodes to the peritoneum and intestines. According to statistics, TB of the mesenteric lymph nodes is most often diagnosed (70 %), the ileocecal region and the peritoneum are affected in 12 % of cases. The clinical picture of abdominal TB is polymorphic, there are no pathognomonic symptoms, therefore, the diagnosis of damage to the abdominal organs is the most difficult in the field of phthisiology. Diagnostic methods that are used: X-ray examination of the small intestine with a contrast agent, irrigoscopy, ultrasonography, computed tomography (CT), laparoscopy and laparotomy with sampling of material for morphological and bacteriological researches. The diagnostic value of CT with bolus enhancement is quite high: sensitivity is 95 %, specificity is 67.5 %. Given the difficulty of confirming the diagnosis of TB, in the case when the diagnosis is not confirmed culturally or histologically, and there is a reasonable suspicion of a specific lesion, which is based on clinical, endoscopic and radiological data, it is recommended to prescribe empirical treatment. Most patients respond positively to anti-TB treatment within 2 weeks. A clinical case of abdominal TB in an HIV-infected patient is described in this article.

A LIP Abdominal Tuberculosis Classification System for Surgery

Tubercular infection can occur in various organs and tissues; however, abdominal tuberculosis is a common form of extrapulmonary tuberculosis after tubercular lymphadenitis. The treatment strategies and surgical indications for different types of abdominal tuberculosis are also not illustrated. This study aimed to create a classification scheme to guide the treatment strategy. The data of abdominal tuberculosis patients admitted to Shaanxi Tuberculosis Hospital from December 2012 to December 2016 were reviewed. All diagnosed abdominal tuberculosis cases were classified into the following 4 types, according to the LIP classification system: lymphatic type (type-L), intestinal type (type-I), peritoneum type (type-P), and mixed type. The differences in medical cure rate, surgical cure rate, postoperative complication rate, and mortality between the patients were compared. The medical cure rate of type-P was the highest of all 4 types (91.7%). The intra-abdominal adhesion of type-I abdominal tuberculosis was milder than those of the other types; hence, laparoscopic surgery can be considered. The incidence of postoperative complications of the mixed type was the highest of the 4 types at 22.7%. The mortality rate of type-L was the highest of the 4 types at 20%. In total, 3 of the 4 deceased mixed patients were found to have L-type abdominal tuberculosis. There were significant differences in the cure rate, complication rate, and mortality rate among the 4 types. The χ2 values were 38.895, 8.253, and 8.601, respectively. The P values were < 0.001, 0.023, and 0.013, respectively. The LIP classification can guide the treatment of abdominal tuberculosis.

A diagnostic approach for differentiating abdominal tuberculosis from ovarian malignancy: a case series and literature review

BackgroundAbdominal tuberculosis is an uncommon variant of extrapulmonary tuberculosis. It accounts for 3.5% of extrapulmonary tuberculosis. Diagnosis of abdominal tuberculosis is still a challenge due to its non-specific symptoms. Abdominal tuberculosis and ovarian cancer may show similar symptoms, laboratory and imaging features. The goal of our report is to emphasize for the need of a diagnostic approach based on clinical manifestations, laboratory, imaging findings, and additional tests for considering a diagnosis of abdominal tuberculosis rather than ovarian cancer.Case presentationWe report 3 cases of abdominal tuberculosis in our Onco-gynaecology Division, Department of Obstetrics and Gynaecology, Sardjito Hospital, Yogyakarta, Indonesia in 2018 which were previously diagnosed as ovarian malignancy and managed surgically. All of our patients experienced abdominal pain and enlargement but only two of them had significant weight loss. The general symptoms were typically found in onco-gynaecology patients, especially in those with ovarian malignancy. Ultrasound examination showed multilocular masses, 2 of them with solid parts and ascites. Cancer antigen 125 (CA-125) levels were found increasing in those three patients. All of them were treated surgically and diagnosis of abdominal tuberculosis was established through the histopathological result of tissue biopsy. Based on our cases and literature, we consider the need of a diagnostic approach to differentiate abdominal tuberculosis from ovarian malignancy, an attempt to avoid unnecessary invasive procedures that put burden risk for the patients.ConclusionMinimally invasive tests to establish the diagnosis of abdominal tuberculosis should be optimized to reduce the burden risk of laparotomy. Careful diagnostic steps should be followed to avoid wrong diagnosis.

Abdominal tuberculosis in urgent surgery

Objective: This article presents retrospective analysis conducted on the basis of the General Surgery Clinic of the Irkutsk State Medical University (ISMU).&#x0D; Materials and methods: 165 cases of abdominal tuberculosis (AT) were detected and analyzed. The sample was made from the total number of patients who were treated in the surgical department for urgent reasons from 2009 to 2018.&#x0D; Results and Discussion: Proportion of hospitalized AT cases from the total number increases every year and slightly decreases only after 2013. The largest number of hospitalizations in 2013 was 29 cases or 2.1%. General characteristics are as follows: 95% of patients were 30–35 years old, 93% used drugs, 80% were HIV positive, and 88.3% suffered abdominal pain. Tuberculosis of the gastrointestinal tract with ulcer perforation was more common (53.7%). 140 (84.5%) patients had history of operation. Overall mortality was 57.6%.&#x0D; Conclusion: The main cause of mortality was generalized tuberculosis. The contribution of these cases to the overall mortality over the period taken was not possible to estimate.&#x0D; Bangladesh Journal of Medical Science Vol.18(4) 2019 p.796-800

CLINICAL PROFILE, DRUG RESISTANCE PATTERN AND TREATMENT OUTCOMES OF ABDOMINAL TUBERCULOSIS PATIENTS IN WESTERN INDIA.

Abdominal tuberculosis is an increasing problem in developing world. The objective of the study was to describe the clinical presentations, drug resistance pattern and treatment outcomes of abdominal tuberculosis in Western India. All the cases of abdominal tuberculosis from May 2014 to April 2017, diagnosed on the basis of clinical profile and gross morphological findings at endoscopy, imaging, followed by histology and/or GeneXpert and MGIT culture were included. All patients received antitubercular drug (AKT) therapy according to national protocol. Patients were followed from diagnoses till completion of treatment and various parameters were studied. Out of the 176 patients, 48% were males. Abdominal pain was most common complaint in 83.5%. On colonoscopy terminal ileum and ileocaecal valve were most commonly involved segments. Upper gastrointestinal tract was involved in four patients. Overall ulceronodular lesions were most common followed by ulcerative/nodular lesion. Strictures in bowel were seen in 28 (15.9%) patients with ileocaecal valve being most commonly involved, of which 23 had symptomatic relief with AKT and only three required dilatation. Histopathology showed granuloma in 80.8% cases. MGIT was positive in 43 (35.80%) cases and GeneXpert was positive in 35 (26.1%) cases. Eight patients had multi drug resistant tuberculosis. Only two patients required surgical management. Abdominal tuberculosis with wide spectrum of presentation, can still be managed with early diagnosis and treatment even in patients with sub acute intestinal obstruction. Weight gain or resolving symptoms were considered early markers of treatment response. Patients with stricture can become asymptomatic with medical treatment alone.

A Single Case Study on treatment of Ileocaecal Tuberculous Sinus with Kadali Kshara Varti

Abdominal tuberculosis (TB) is an uncommon affliction in adolescence. It is usually associated with pulmonary tuberculosis. The disease is caused by lymphohaematogenous spread after primary infection in the lung or ingestion of infected sputum and has a typically nonspecific presentation. The occurrence of ileocaecal TB is probably from the contiguous spread of an abdominal focus or mesenteric lymph node. Ileocaecal TB is a rare entity, with very few reported cases in the literature. We report here a case of abdominal TB that manifested in the infection of an abdominal wall resulting in sinus at inguinal region and there by highlighting the Ayurvedic management of abdominal sinus by the use of Kshara Varti. Kshara Varti is the chief modality in the treatment in the Ayurvedic science and has been explained in Nadivrana.

Computed tomographic features of abdominal tuberculosis: unmask the impersonator!

Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.

АБДОМИНАЛЬНЫЙ ТУБЕРКУЛЕЗ В РАБОТЕ ВРАЧА ОБЩЕЙ ПРАКТИКИ

Last years are marked by the increased number of cases of extra pulmonary localizations of tubercular process that are proved by the numerous publications. The diagnostics of these forms of tuberculosis is not easy because it requires a detailed examination of the patient. Cases of abdominal tuberculosis are among them. The article contains the data of modern medical literature on extra pulmonary forms of tuberculosis and information of clinical cases of posthumous diagnostics of tuberculosis of serous membranes of abdominal cavity and lungs.

Dilemma Continues – Abdominal Tuberculosis or Abdomininal Lymphoma

Tuberculosis is a disease that has long been there since ages and is a threat as it was. Abdominal tuberculosis is espacially common in endemic regions and with its varying and non-specific presentation may mimic a variety of disorders ranging from benign to malignant. It has a concealing effect as well and tends to mask diseases that are of entirely different character. All of this creates a diagnostic dilemma for the clinician. we present a similar case which was as non-specific as it could be. We presented here a patient who after undergoing more than 3 colonoscopies, being labelled lymphoma twice, registered for chemotherapy and most of the conventional tubercular markers being negative, still turned out to be a case of abdominal tuberculosis.

Abdominal tuberculosis presenting as mass per abdomen: a case report

Tuberculosis (TB) can involve any part of the gastrointestinal tract, the peritoneum, lymphnodes and the pancreatobiliary system. The primary site of TB is usually lung, from where it disseminates to other parts of the body. TB of the gastrointestinal tract is the sixth most frequent form of extrapulmonary tuberculosis. The incidence of abdominal tuberculosis in children in India is estimated to be 2.2 million as in the year 2014 and India has the world’s largest tuberculosis cases of around 26%. It can have a varied presentation and can mimic any abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Here we present a case of abdominal tuberculosis who presented as mass per abdomen.

Diagnosis of Abdominal Tuberculosis Needs Attention.

Dear Editor, We read with keen interest the article titled BStudy of surgical emergencies of tubercular abdomen in developing countries^ by Wani et al. published in the May–June 2015 issue of the Indian Journal of Surgery. The authors have presented 50 patients of tubercular abdomen. The inclusion criteria for patient selection and the diagnostic criteria used to label the patient as a case of abdominal tuberculosis (AT) has not been specified. The authors mentioned rates of positivity of PCR and IgM ELISA for blood and ascitic fluid and its sensitivity. The details of test-kit used for IgM ELISA have not been mentioned. Absolute number of tests on ascitic fluid is not mentioned; ascites was present in a small proportion of patients (n=8). It is not mentioned what gold standard was used for calculating sensitivity for these tests. The authors have not taken into consideration the specificity of these tests for diagnosis of AT. Histopathology test was reported to confirm the diagnosis in 97.8 % patients; however, the histopathological criteria for diagnosing AT have not been mentioned. The proportion of patients who required surgery on failure of initial conservative antituberculosis treatment (ATT) has not been mentioned. Clarification on these points will enhance the value of the observations. A number of tests are being used for confirming the clinical diagnosis of AT. AT being an infective disease, the demonstration of Mycobacterium tuberculosis (MT) from the abdominal lesions would be an ideal criterion for diagnosis; however, the yield ofMTon tissue sections is poor [1]. The demonstration of AFB on Ziehl-Nielsen staining or demonstration of caseating granulomas in abdominal specimen is the next acceptable level of evidence for diagnosis for AT. Diagnosis on the basis of nonspecific granulomas would be a matter of conjecture as several other diseases—notably Crohn’s disease, Ulcerative colitis, Salmonella, Yersinea, Histoplasma capsulatum, and Mycobacteriun capsulatum infection—can produce granulomas in the intestine, lymph nodes, and/or peritoneum. It is difficult to establish evidence-based diagnosis of AT due to difficulty in obtaining specimen for testing and low positivity of accepted criteria. The CT scan is a valuable adjunct in diagnosing ATas it can document typical lesions in intestine, lymph nodes, and omentum, and collections of exudates in abdomen. CT facilitates image guided FNAC and aspiration to collect specimen for cytological / microbiological tests . Demonstration of MT, AFB, caseating granulomas in specimens from other organ/systems like sputum, urine, and FNAC from extra-abdominal lymph nodes, and biopsy from endometrium may corroborate the CT and increase the level of confidence of the diagnosis of AT. Laparoscopy has an important role in demonstrating the typical abdominal lesions and facilitating collection of exudates/tissue specimen for testing. Commercial serological tests provide inconsistent and imprecise findings resulting in highly variable values for sensitivity and specificity. WHO has strongly recommended that these tests not be used for the diagnosis of pulmonary and extrapulmonary TB [2]. Reported high positivity of PCR from blood (72%) is an interesting finding, and its value in diagnosis of AT needs further evaluation. Empirical treatment with ATT should be prescribed only after due diligence, based on available * Bhupendra Kumar Jain bhupendrakjain@gmail.com

Abdominal tuberculosis: an epidemiological profile and management of 40 cases in a tertiary set up

Background: Tuberculosis is the most important communicable disease world-wide. It is an important cause of morbidity in India. Abdominal tuberculosis mimicks most abdominal diseases and hence is a difficult diagnosis. This study aims to document the epidemiological profile and management strategies of abdominal tuberculosis according to various sites and surgical pathology. Methods: Forty new cases of abdominal tuberculosis were diagnosed and treated over a period of one year (2014-2015) in surgical wards of Shyam Shah Medical College and associated Sanjay Gandhi Memorial Hospital, Rewa (M.P). The patients were selected after they were diagnosed as abdominal tuberculosis on the basis of clinical history, thorough clinical examination and clinical picture during surgery. Further diagnosis was confirmed by histopathology and tissue culture studies. All the patients diagnosed with abdominal tuberculosis, were put on ATT for a period of 6 month, and they were asked to present themselves for follow up at regular intervals. Results: Out of 40 patients with abdominal tuberculosis, 26 were males (65%) and 14 (35%) were females. male to female ratio was 1.8:1. Adults in their 3rd decade (37.5%) and 4th decade (22.5%) were most commonly affected. Pain abdomen was the most common presenting complaint present in 82.5% cases. Abdomen distension was the most common sign (75%). Pulmonary tuberculosis was associated with in 22.5% cases. 5% cases of abdominal tuberculosis were co infected with HIV infection. 55% cases underwent surgical management followed by ATT, and 45% cases needed only ATT as treatment. In cases explored surgically, ulcero sclerotic type (ileal stricture with perforation) was the most common pathology seen in 31.8% cases. Ileocecal region was the most common site of involvement with 67.3% occurrence. Mortality rate was 5%. Conclusions: Abdominal tuberculosis is predominantly seen in low socio economic group. Adults in their 3rd and 4th decades are most commonly affected, which is the earning age group and hence can have economic implications. Majority of cases were of primary intestinal type and in some it was secondary to pulmonary tuberculosis. Majority of cases underwent surgical management followed by ATT. Anti tuberculosis therapy is still the treatment of choice in abdominal tuberculosis and surgery is only indicated in various complication of abdominal tuberculosis.

PWE-435 Abdominal tuberculosis – 10 year experience from a uk district general hospital

Introduction The rate of tuberculosis has remained relatively stable over the past decade. However, the proportion of cases with extra-pulmonary disease has increased from 40.9% to 47.9%. Multiple studies have shown that diagnosis of abdominal tuberculosis (ATB) is often delayed due to non-specific symptoms in patients. The aim of this study was to examine a selection of patients from a UK district general hospital with a diagnosis of ATB and the process in which that diagnosis was reached. Method We performed a retrospective review of all patients at Russells Hall Hospital, Dudley, who had a diagnosis of ATB between 2004 and 2014. Demographic, clinical, laboratory and radiographical findings were collated including the time delay between hospital presentation and diagnosis. Results Sixteen cases of ATB were identified with a median age of 38.5 years at time of diagnosis (range 22–73 years) with a male gender of 56%. The majority (87.5%) were of non-white background; South Asian (69%), Afrocaribbean (19%) and White British (12%). The commonest features were abdominal pain (62.5%), weight loss (50%) and fevers (50%). The time between first presentation to hospital and diagnosis ranged from 2 days to 3 years. Basic investigations revealed mean haemoglobin of 11.9 ± 1.7 g/dL, CRP of 109 ± 92 mg/L, alkaline phosphatase of 200 ± 160 IU/L, and albumin of 37.1 ± 6.5 g/L. The chest x-ray was normal in 11 patients; abnormalities seen were consolidation in 3 patients and a cavitating lesion in 1 patient. One patient did not have an x-ray. There was a wide range of sites of disease including small bowel (25%), peritoneum (25%), lymph nodes (18.75%), appendix (12.5%), liver (12.5%) and omentum (6.25%). Tuberculin test was only performed in three patients and all of which were positive. Diagnosis was based on histology (43.75%), imaging (31.25%), microbiology (6.25%), or a combination of clinical suspicion and imaging or appearances at surgery (18.75%). The majority who received treatment (9/14) were given Rifater plus ethambutol. The remaining five patients all received a different combination of antituberculous treatment (Rifater alone, Rifinah ± Pyrazinamide and Ethambutol, Rifampicin/Isoniazid/Pyrazinamide ± Ethambutol). Two patients did not receive treatment as their diagnosis was made post-mortem. Of the sixteen patients, ten were treated and discharged, three died, two have on-going review and one was lost to follow up. Conclusion ATB is a difficult diagnosis to make and there can be a significant time delay between symptom onset and diagnosis as the symptoms can be varied and insidious in nature. It is an easily treatable condition and a combination of abdominal pain, fevers and weight loss in a non-Caucasian patient should raise suspicion and warrants further investigation. Disclosure of interest None Declared.

A case of abdominal tuberculosis with regional portal hypertension

A case of abdominal tuberculosis with regional portal hypertension

PTU-090 10 Year Retrospective Review Of Abdominal Tuberculosis From A London Teaching Hospital: Age, Ethnicity And Hiv Status

IntroductionAlthough tuberculosis (TB) rates in United Kingdom have plateaued in recent years, areas with large high risk non-UK born population, which are predominantly centred in large urban areas, still have...

PTU-030 10 Year Retrospective Review Of Abdominal Tuberculosis From A London Teaching Hospital: Diagnostic Methods

IntroductionAbdominal tuberculosis (TB) is difficult to diagnose, due to non-specific symptoms and radiological, histological and endoscopic similarity to other conditions. It can mimic Crohn’s disease and should always be considered...