Afridi Shahida Parveen, Siddiqui Rameez Ahmed, Rajput Akram, Alam Shams Nadeem
Department of General Surgery, Dow University of Health Sciences and Civil Hospital Karachi, Pakistan.
Medical Student, Dow international Medical College, Karachi, Pakistan.
J Pak Med Assoc. 2016 Sep;66(9):1173-1175.
The study highlights the spectrum of abdominal TB in emergency surgery and its outcome. A proforma based prospective cross sectional study was conducted from March 2008 - March 2014, at the Department of General Surgery, Dow University of Health Sciences & Civil Hospital Karachi, Pakistan. Total patients studied were hundred. Ninety percent patients presented through the emergency department. Mean age was 30 ± 7.29 years. Family history of TB was positive in 46 (46%) patients. Pulmonary TB was present in 22 (22%), and 52 (52%) - were already on Antitubercular Therapy-- Emergency exploratory laparotomy was performed in 85 (85%) patients with 61 (61%) having peritonitis. and 24 (24%) having acute intestinal obstruction. A total of 15 (15%) patients were kept on ATT under observation, Of these 7(7%) were diagnosed with Ileocaecal mass, 5 (5%) with enterocutaneous fistula, and 3(3%) had sub-acute intestinal obstruction. Ileum was the most common site for abdominal TB in 36(36%), followed by ileocaecal TB in 13 (13%) and jejunal TB in 12 (12%). Stoma and abdominal washout was the minimum procedure which was performed in 34 (34%) cases. Fourteen (14%) patients diagnosed with ileocaecal TB, received limited right hemi colectomy with two end stoma whereas 7(7%) patients were subjected to limited right hemi colectomy with primary anastomosis. Patients with multiple strictures and perforations were subjected to segmental resection with two end stoma. This was performed, in 12 (12%) cases and primary repair and anastomosis in 9 (9%). Only washouts and laparostomy was performed in 5 (5%) and adhenolysis in 4(4%) cases. Redo surgery was required in 44 (44%). The overall mortality was 18%. This study concludes that abdominal TB patients usually present late with complications in emergency surgery because of diagnostic delay, having a high morbidity and mortality.
该研究强调了急诊手术中腹部结核的范围及其结果。2008年3月至2014年3月，在巴基斯坦卡拉奇道健康科学大学和市民医院普通外科进行了一项基于表格的前瞻性横断面研究。共研究了100例患者。90%的患者通过急诊科就诊。平均年龄为30±7.29岁。46例（46%）患者有结核病家族史。22例（22%）有肺结核，52例（52%）已在接受抗结核治疗。85例（85%）患者接受了急诊剖腹探查术，其中61例（61%）患有腹膜炎，24例（24%）患有急性肠梗阻。共有15例（15%）患者在观察下接受抗结核治疗，其中7例（7%）被诊断为回盲部肿块，5例（5%）患有肠皮肤瘘，3例（3%）患有亚急性肠梗阻。回肠是腹部结核最常见的部位，占36%（36例），其次是回盲部结核，占13%（13例），空肠结核占12%（12例）。造口术和腹腔冲洗是最少实施的手术，在34例（34%）病例中进行。14例（14%）被诊断为回盲部结核的患者接受了有限的右半结肠切除术并带有两个末端造口，而7例（7%）患者接受了有限的右半结肠切除术并进行一期吻合。有多处狭窄和穿孔的患者接受了带有两个末端造口的节段性切除术，这在12例（12%）病例中进行，9例（9%）进行了一期修复和吻合。仅5例（5%）进行了冲洗和剖腹术，4例（4%）进行了粘连松解术。44例（44%）需要再次手术。总体死亡率为18%。本研究得出结论，腹部结核患者在急诊手术中通常因诊断延迟而出现并发症较晚，发病率和死亡率较高。
