Abdominal Tuberculosis: Analysis of clinical features and outcome of surgical management in adult patients in RGGGH

Selvaraj, S (2016) Abdominal Tuberculosis: Analysis of clinical features and outcome of surgical management in adult patients in RGGGH. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION Tuberculosis is one of the most prevalent communicable disease in India. Despite several populistic measures to control the spread of tuberculosis and to improve upon the early identification of patients and proper management protocols, the disease continues to be rampant. With the advent of the multi drug therapy regimen the incidence of pulmonary tuberculosis and mortality due to the same has reduced. But at the same time extra pulmonary form of tuberculosis is on the rise. In spite of considerable advances in recent times, tuberculosis, particularly of abdomen, still continues to be a major health problem in India. Abdominal tuberculosis (ATB) is a great mimic and an importantcause of morbidity AIMS & OBJECTIVES 1. To study the various clinico-pathological manifestations of abdominal tuberculosis. 2. To study the various factors determining the surgical management of abdominal tuberculosis 3. To study the various surgical treatment modalities, their complications & outcome in the management of abdominal tuberculosis. 4. To correlate the clinical, imaging and histopathological features MATERIALS & METHODS Its a prospective and retrospective observational study. Method of sampling was non-random, purposive. Those patients whose imaging, intraoperative findings or histopathology was suspicious of tuberculosis were included in the study. Informed written consent was taken from the patients or their guardian willing to participate in the study. Detailed history was taken from the study group to establish proper diagnosis. Thorough physical examination was done in each case. Data collection sheets were filled in by the investigator himself. The operation procedure and related peroperative factors were observed directly and recorded in the data collection sheet instantly. After completing the collection of data it was compiled in a systematic way and analysed RESULTS & DISCUSSION The incidence of abdominal tuberculosis causing acute abdomen and requiring emergency millie laparotomy is on the rise. The common procedures performed included primary closure of perforation incase of small isolated perforations with not much contamination. Resection followed by either anastomosis or stomas was done in most of the patients. Even in those patients who had anastomosis, a covering stoma was placed as the healing process in these patients may be impaired. The prevalence of morbidity in these patients were similar to any group of patients undergoing emergency laparotomy. There was no age or sex predilection. Presence of a systemic disease and immunocompromised patients had increased tendency to develop post operative morbidity and mortality. Overall, prognosis is good in patients provided with early intervention, intensive post operative management while ensuring the completion of course of anti tubercular drugs. CONCLUSION 1. Abdominal Tuberculosis should be a part of the differential for patients presenting with acute abdomen 2. Identification of the disease in its early stages, when the patients has only non specific symptoms is essential. 3. In immunocompromised patients or patients with pulmonary tuberculosis, any abdominal symptoms has to be properly evaluated. 4. The prognosis, if properly managed is very good, so proper management protocols need to be established 5. Further large scale studies have to be initiated to determine methods of early diagnosis and to reduce the morbidity of the disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Abdominal Tuberculosis ; Analysis ; clinical features ; outcome ; surgical management ; adult patients ; RGGGH
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 01:51
Last Modified: 27 Sep 2017 01:51
URI: http://repository-tnmgrmu.ac.in/id/eprint/3374

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