Barot Mithun, Yagnik Vipul D, Patel Kirankumar, Dawka Sushil
Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India.
Department Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India.
Tzu Chi Med J. 2020 Dec 24;33(3):282-287. doi: 10.4103/tcmj.tcmj_206_20. eCollection 2021 Jul-Sep.
Tuberculosis (TB) can affect any part of the gastrointestinal tract. It is estimated that in 2018, 10 million people were affected with TB worldwide and there were 1.2 million TB deaths among human immunodeficiency virus-negative people. India has the highest TB burden in the world (27%), a significant proportion of which are of intestinal TB. The aims of this study were to assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and its management.
From October 1, 2014, to October 30, 2016, a total of 50 patients meeting the inclusion criteria for the study, age between 15 and 65 years and diagnosis of symptomatic intestinal TB requiring surgery, were enrolled in the study. We used descriptive statistics to analyze the data.
Abdominal TB was most commonly seen in young adults. Intestinal obstruction was the most frequent presentation. The most common site of involvement in the present study was the ileum. Ultrasonography (USG) and X-ray were an integral part of the diagnosis, with computed tomography (CT) scan being rarely required. Although both anemia and erythrocyte sedimentation rate (ESR) are nonspecific, they may help in supporting the clinical and pathological findings. Most operations were elective, with intestinal obstruction being the most common indication and resection and end-to-end anastomosis performed most often. Histopathological examination was performed in all patients and showed caseating granuloma in 90% of cases, while 10% of cases had chronic noncaseating granulomas with ill-defined aggregates of epithelioid histiocytes.
Abdominal TB causes a significant problem in diagnosis due to nonspecific symptomatology and lack of specific laboratory tests. USG and X-ray were an integral part of the diagnosis. CT scan is rarely required. Although anemia and ESR are both nonspecific features, they may help in supporting the clinical and pathological findings. The most common site of involvement in the present study was the ileum. Intestinal obstruction was the most common indication for operation, with resection and end-to-end anastomosis being the most common operation. The mainstay of treatment is medical therapy and timely surgical intervention is required in a sizable number of patients.
结核病可累及胃肠道的任何部位。据估计，2018年全球有1000万人感染结核病，在人类免疫缺陷病毒阴性人群中有120万人死于结核病。印度的结核病负担全球最高（27%），其中很大一部分是肠结核。本研究的目的是评估腹部结核病诊断的临床特征和检查方法，并分析其各种手术表现及治疗方法。
2014年10月1日至2016年10月30日，共有50例符合研究纳入标准的患者纳入研究，年龄在15至65岁之间，诊断为有症状的肠结核且需要手术治疗。我们使用描述性统计方法分析数据。
腹部结核最常见于年轻人。肠梗阻是最常见的表现形式。本研究中最常受累的部位是回肠。超声检查（USG）和X线检查是诊断的重要组成部分，很少需要计算机断层扫描（CT）。虽然贫血和红细胞沉降率（ESR）都不具有特异性，但它们有助于支持临床和病理检查结果。大多数手术是择期手术，肠梗阻是最常见的手术指征，最常进行的手术是切除和端端吻合术。所有患者均进行了组织病理学检查，90%的病例显示干酪样肉芽肿，而10%的病例有慢性非干酪样肉芽肿，上皮样组织细胞聚集不明确。
由于症状不具特异性且缺乏特异性实验室检查，腹部结核在诊断方面存在重大问题。超声检查和X线检查是诊断的重要组成部分。很少需要CT扫描。虽然贫血和ESR都是非特异性特征，但它们有助于支持临床和病理检查结果。本研究中最常受累的部位是回肠。肠梗阻是最常见的手术指征，切除和端端吻合术是最常见的手术方式。治疗的主要方法是药物治疗，相当一部分患者需要及时进行手术干预。
