Prevalence of Tubercular Perforation in Acute Abdomen

Abstract

Background: Tuberculosis is an important cause of morbidity in Pakistan. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose.Most of the patients with abdominal tuberculosis presents with acute abdomen. Objective: This study aims to document the prevalence of tuberculous gut perforations in patients of acute abdomen. The study also discusses the indications and extent of surgical intervention. Study design: This was randomized prospective study of 247 patients who presented with acute abdomen. Settings: Surgical Unit of Sheikh Zayed Hospital, Rahim Yar Khan. Period: 2 years from 1^st May 2014 to 30^th April 2016. Methodology: Patients of abdominal trauma both blunt and penetrating were excluded from the study. Patients were mostly admitted through the Casualty department.  A specially designed proforma was filled in for every patient. Parameters studied included age, sex, socio-economic condition, past history of TB, family history, medical history and surgical history. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology. All patients were subsequently treated with a full course of antitubercular drugs (ATD). Patients were followed up for six months. Results: 247patients presented with acute abdomen with male prevalence (male to female ratio 2.5:1). 40 patients were diagnosed as abdominal tuberculosis with female to male ratio of 1.85:1. There were 17 cases of tuberculous gut perforations. Different surgical procedures done in patients of tuberculous gut perforations. Most of postoperative complications were seen in patients of tuberculous gut perforations and patients developed more than one complications Patients of tuberculous gut perforations carried high morbidity and mortality  rate of 35.29%. Conclusion: Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented. In our area tuberculous gut perforations is more common due to delay in diagnosis and low socio-economic status. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a full ATT.