TUBERCULOSIS AS A SURGICAL DISEASE OF THE ABDOMEN

Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis

From 1965 to 1989, 60 cases of large bowel tuberculosis among 116 cases of abdominal tuberculosis are reviewed and analyzed. Lesions located in the cecum or ileocecal region were found in 49 of the 60 cases. Most of the patients (50/60) received surgical intervention, but the definite diagnoses had never been proved until surgery. The diagnoses were proved by histopathologic examination in these 50 cases. Antituberculosis medications were given for at least nine months in all patients. Twenty-nine of the 50 patients who received operations had primary anastomosis during the operations, and no leakage occurred. Evidence of pulmonary tuberculous lesions could be found in 40 of the 60 cases. Positive findings of tubercle bacilli in sputum smear or culture were noted in 13 cases. The positive rate of sputum examinations decreased during 1980 to 1989; 25.6 percent (10/39) were positive from 1965 to 1979 and 14 percent (3/21) were positive from 1980 to 1989. In the meantime, there was a steady decline in the cases of large bowel tuberculosis in the most recent few years. An antituberculosis program has been carried out in the past 40 years with remarkable effect in the Taiwan area, but the possibility of intestinal tuberculosis still exists. The authors suggest that surgeons keep tuberculosis in mind when they are dealing with patients who suffer from intestinal obstruction of unknown origin with the suspected findings of pulmonary tuberculosis in chest x-ray films.

Modified surgical procedures in intestinal tuberculosis

The results of modified surgical procedures in intestinal tuberculosis in 79 patients are presented. Special emphasis is laid on the role of limited ileocaecal resection and ileoplasty. These procedures are safe, quick and easy with preservation of functional portions of the bowel. They are of immense value in emergencies in chronically ill and emaciated patients.

Intestinal and peritoneal tuberculosis: report of two cases

One hundred and seven cases of abdominal tuberculosis were analyzed. There were no specific laboratory or x-ray findings pathognomonic of abdominal tuberculosis. Leukopenia was often found, but was nonspecific. An abdominal tumor was often palpable. A great rarity in our series was profuse hemorrhage from a jejunal tuberculous ulcer; the patient had to be subjected to an emergency operation. In another case tuberculosis appeared in a side-to-side small intestinal anastomosis and in its blind ends, which had developed as a late complication. The diagnosis of abdominal tuberculosis must be confirmed by histologic examination of biopsy specimens; if the results are inconclusive, acid-fast bacilli must be seen or culture should be positive. Guinea-pig inoculation is rarely positive, probably owing to the low virulence of the tuberculous bacteria in abdominal tuberculosis. Good results are obtained with chemotherapy in both intestinal and peritoneal tuberculosis. The complications, obstruction being most usual, must be surgically treated. Resection of the affected segment is the best surgical procedure. For ileocecal tuberculosis, right hemicolectomy was performed. According to the authors, roentgenographic evidence of tuberculosis in the abdomen must always be confirmed by operation, because differentiation from carcinoma and other inflammatory lesions is impossible. For good results after operation, anti-tuberculosis chemotherapy is mandatory.

Abdominal tuberculosis

Twelve cases of abdominal tuberculosis are presented. They illustrate the great variability in the clinical features of this condition, making diagnosis extremely difficult. In particular, we draw attention to the problem of tuberculosis of the reticuloendothelial system in the abdomen. Biopsy and culture are essential at laparotomy if a correct diagnosis is to be made.