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Ray D, Thukral BB, Gupta R, Chintamani, Prasad R. Small bowel tuberculosis by multidetector CT enteroclysis. Jpn J Radiol 2013; 31:471-9. [PMID: 23733331 DOI: 10.1007/s11604-013-0220-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/18/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively evaluate the role of multidetector computed tomography (CT) enteroclysis in evaluation and diagnostic characterization of suspected small bowel tuberculosis. MATERIALS AND METHODS The study group included 21 human subjects suspected of having small bowel tuberculosis. A nasoenteric tube was positioned into the duodenojejunal junction under fluoroscopic guidance and water was infused by hand injection. After intravenous administration of 120 mL of iodinated contrast material, multidetector CT enteroclysis images were obtained with 40 × 0.625 mm collimation and findings were analyzed by three readers working in consensus. Findings were compared with the results of endoscopy, histopathological analysis, and clinical follow up. RESULTS Multidetector CT enteroclysis was well tolerated in 20 patients; one of the patients complained of vomiting during intubation. Using multidetector CT enteroclysis diagnosis of abdominal tuberculosis was made in sixteen patients, out of which small bowel involvement was seen in 13 patients. Multidetector CT enteroclysis demonstrated Crohn's disease in one patients and normal in four patients. The sensitivity and specificity in diagnosing abdominal tuberculosis by CT enteroclysis came out to be 93.75 and 100 % respectively. CONCLUSIONS Multidetector CT enteroclysis is well tolerable and accurate modality for evaluation and diagnostic characterization of small bowel tuberculosis.
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Affiliation(s)
- Dhirendra Ray
- Department of Radiology, VMMC and Safdarjung Hospital, 110 A, Arjun Nagar, Safdarjung Enclave, New Delhi, 110029, India.
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Acute HIV-related gastrointestinal disorders and complications in the antiretroviral era: spectrum of cross-sectional imaging findings. ACTA ACUST UNITED AC 2013; 38:994-1004. [DOI: 10.1007/s00261-013-9982-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yadav D, Garg PK. Spectrum of perforation peritonitis in delhi: 77 cases experience. Indian J Surg 2012; 75:133-7. [PMID: 24426408 DOI: 10.1007/s12262-012-0609-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/06/2012] [Indexed: 12/18/2022] Open
Abstract
Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8 months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4 %) and ileal typhoid perforation (26.4 %), each followed by small bowel tuberculosis (10.3 %) and stomach perforation (9.2 %), perforation due to acute appendicitis (5 %). The highest number of perforations was seen in ileum (39.1 %), duodenum (26.4 %), stomach (11.5 %), appendix (3.5 %), jejunum (4.6 %), and colon (3.5 %). Overall mortality was 13 %. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup.
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Akbulut S, Yagmur Y, Bakir S, Sogutcu N, Yilmaz D, Senol A, Bahadir MV. Appendicular tuberculosis: review of 155 published cases and a report of two cases. Eur J Trauma Emerg Surg 2010; 36:579-85. [PMID: 26816314 DOI: 10.1007/s00068-010-0040-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/07/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE This paper provides an overview of the literature on appendicular tuberculosis (ATB) between 1909 and 2010. METHODS We present two cases of primary ATB and a literature review of studies on ATB published in English and accessed via the Pubmed and Google Scholar databases. RESULTS One hundred fifty-five published cases of ATB were reviewed, and two patients with primary ATB, treated and followed in our clinic, were reported. The age range of the patients (62 females, 60 males and 33 with unnoted gender) was between 2 and 60 years, with a mean age of 27.1 ± 10.6 years. Of the patients who had applied to hospital, 59 had acute right lower quadrant pain, 46 had recurrent right lower quadrant pain, 19 had generalized pain, and 10 had chronic abdominal symptoms suggestive of subacute intestinal obstruction, while 47 patients were operated on with a diagnosis of acute appendicitis, 24 with recurrent appendicitis, 19 with TB peritonitis, 14 with mass in the right lower quadrant, 13 with subacute intestinal obstruction, and 7 with ATB. While appendectomy was not performed on 4 patients, one or more of the following procedures were done in the other 151 cases: appendectomy, hemicolectomy, ileocecal resection, or cecectomy. Different anti-tubercular treatment regimens with durations varying from 3 weeks to 18 months were applied to 60 patients. During the follow-up period of 3 weeks to 15 years, mortality occurred in 14 patients, sinus in five, and fistula in one patient. Secondary ATB was detected in 86 patients, primary ATB in 50, and no differential diagnosis could be made in 19 cases. CONCLUSIONS Tuberculosis is a systemic disease with localized manifestations; therefore, anti-TB therapy must be initiated in any patient whose pathologic specimen reveals tuberculosis.
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Affiliation(s)
- S Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, 21400, Turkey.
| | - Y Yagmur
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, 21400, Turkey
| | - S Bakir
- Department of Pathology, Diyarbakir Education and Research Hospital, Diyarbakir, 21400, Turkey
| | - N Sogutcu
- Department of Pathology, Diyarbakir Education and Research Hospital, Diyarbakir, 21400, Turkey
| | - D Yilmaz
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, 21400, Turkey
| | - A Senol
- Department of Radiology, Diyarbakir Education and Research Hospital, 21400, Diyarbakir, Turkey
| | - M V Bahadir
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, 21400, Turkey
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Abstract
BACKGROUND Abdominal tuberculosis (TB) includes infection of the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. The most common forms of abdominal TB in children are adhesive peritonitis and nodal disease. PATIENTS AND METHODS We report our experience with abdominal TB treated in our hospital from 1995 to 2008. RESULTS Thirteen patients (3 boys and 10 girls) of mean age 9.8 years were diagnosed as having abdominal TB. Eight patients presented with abdominal distension and abdominal pain. Fever was seen in 4 patients. One patient had surgical abdominal pain and 2 had abdominal mass. Two patients had coexisting pleural effusion and 1 of them had multifocal TB. Abdominal TB involved peritoneum in 9, abdominal lymph nodes in 7, gastrointestinal tract in 3, spleen in 2 patients, and liver in 1. Ascitic fluid analysis of 9 patients showed exudative fluid with predominately lymphocytes. Laparotomy was performed in 3 patients. The diagnosis of abdominal TB was confirmed histopathologically in 5 patients and microbiologically in 3. The remaining patients had been diagnosed by ascitic fluid diagnostic features, abdominal imaging, tuberculin skin test, history of exposure, and a positive response to antituberculous treatment. Twelve patients completed the antituberculous therapy without any complications. One patient with multifocal TB had neurological sequelae. CONCLUSIONS In the areas with a high prevalence of tuberculosis and confirmatory investigations are inadequately available, treatment may be initiated, based on strong clinical diagnosis and supportive investigations. In such situations, it is the response to therapy that indirectly proves the diagnosis.
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Chahed J, Mekki M, Mansour A, Ben Brahim M, Maazoun K, Hidouri S, Krichene I, Sahnoun L, Jouini R, Belgith M, Zakhama A, Sfar MT, Gueddiche MN, Harbi A, Amri F, Mahfoudh A, Nouri A. Contribution of laparoscopy in the abdominal tuberculosis diagnosis: retrospective study of about 11 cases. Pediatr Surg Int 2010; 26:413-8. [PMID: 20162421 DOI: 10.1007/s00383-010-2555-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2010] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Abdominal tuberculosis is one of the most frequent extra-pulmonary localizations. Its diagnosis is difficult and may lead to a delayed prescription of specific treatment. This study is aimed at stressing the role of laparoscopy associated with a biopsy in the diagnostic confirmation of abdominal tuberculosis particularly in doubtful cases. METHODS The diagnostic features of 11 cases hospitalized for abdominal tuberculosis in the Paediatric Surgery Department of Fattouma Bourguiba Hospital in Monastir for a 6-year period (2001-2006), were evaluated retrospectively. The diagnosis of abdominal tuberculosis was substantiated histopathologically by laparoscopy in all cases. The epidemiological and clinical characteristics along with the laboratory, radiological and histological data were studied. RESULTS Eleven cases of abdominal tuberculosis with a mean age of 5.6 years were diagnosed. It was peritoneal tuberculosis in all cases and associated with intestinal localization in one case. A conversion to laparotomy was practiced in three patients: appendicular plastron in one case, pseudo-tumor aspect of an intestinal loop in another case and because of their pathological aspect appendicectomy and caecum biopsy in the third. The diagnosis was confirmed histologically by biopsies in nine cases and on excision pieces in the other two cases. All patients had an uneventful course with an antituberculosis treatment. CONCLUSION Abdominal tuberculosis is still frequent in Tunisia. Because of its non-specific clinical presentation and the limited means of investigation, a laparoscopy with biopsy should be practiced as first line diagnostic tool in case of doubtful abdominal tuberculosis. The earlier the diagnosis is established and an adapted antituberculosis treatment is started, the better the prognosis is.
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Affiliation(s)
- Jamila Chahed
- Paediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.
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[Pseudotumor colic tuberculosis: an exceptional cause of massive surgical bleeding]. Presse Med 2010; 39:515-7. [PMID: 20097514 DOI: 10.1016/j.lpm.2009.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 03/16/2009] [Accepted: 03/27/2009] [Indexed: 11/24/2022] Open
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Afridi SP, Malik F, Ur-Rahman S, Shamim S, Samo KA. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience. World J Emerg Surg 2008; 3:31. [PMID: 18992164 PMCID: PMC2614978 DOI: 10.1186/1749-7922-3-31] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 11/08/2008] [Indexed: 03/05/2023] Open
Abstract
Background Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. Methods A prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK) Pakistan, from 1st September 2005 – 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. Results The most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6%) and gastric ulcer 1.3%. followed by small bowel tuberculosis (21%) and typhoid (17%). large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%). Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%). Conclusion The spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular. Malignant perforations are least common in our setup.
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Affiliation(s)
- Shahida Parveen Afridi
- Department of General Surgery, Dow University of Health Sciences and Civil Hospital, Karachi, Pakistan.
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Acer T, Karnak I, Ekinci S, Talim B, Kiper N, Senocak ME. Multiple jejunoileal perforations because of intestinal involvement of miliary tuberculosis in an infant. J Pediatr Surg 2008; 43:e17-21. [PMID: 18778982 DOI: 10.1016/j.jpedsurg.2008.03.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 03/22/2008] [Accepted: 03/26/2008] [Indexed: 11/27/2022]
Abstract
Infants are more susceptible to tuberculous bacilli and may develop severe extrapulmonary and miliary forms of the disease. However, miliary tuberculosis (MT) presenting with multiple intestinal perforations as an initial manifestation of the disease is extremely rare in children. The authors describe an infant who underwent emergency laparotomy because of jejunoileal perforations secondary to intestinal involvement of MT to emphasize the characteristics of the abdominal disease and the importance of controlling systemic disease to achieve a favorable outcome.
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Affiliation(s)
- Tuğba Acer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Sihhiye Ankara 06100, Turkey
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Abstract
The diagnosis of an abdominal mass using imaging techniques is difficult for clinicians and radiologists. We report a case of an atypical peripancreatic mass, mimicking a carcinoma on abdominal computed tomography and which was only diagnosed after an echoendoscopic biopsy of the mass was performed. It is difficult to differentiate abdominal tuberculosis from a neoplasm, especially if there is no pulmonary tuberculosis. Usually, the diagnosis of abdominal tuberculosis is only confirmed histologically, after surgical resection of the mass. Echoendoscopic biopsy confirmed the infectious nature of the mass and prevented complicated and difficult surgery.
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Abstract
Gastrointestinal tuberculosis represents 1% of extrapulmonary tuberculoses and only sporadic cases of anal tuberculosis have been reported in the literature. We report two cases of tuberculous anal abscess and a review of the literature for diagnosis and treatment.
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El Abkari M, Benajah DA, Aqodad N, Bennouna S, Oudghiri B, Ibrahimi A. Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases. ACTA ACUST UNITED AC 2006; 30:377-81. [PMID: 16633302 DOI: 10.1016/s0399-8320(06)73191-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS Peritoneal tuberculosis is an important public health issue in Morocco. Our aim was to describe the clinical, biological, and therapeutic features of peritoneal tuberculosis treated in a University Hospital in Morocco. PATIENTS AND METHODS We retrospectively included 123 patients with peritoneal tuberculosis diagnosed at the gastroenterology unit of the Fes University Hospital between January 2001 and August 2003. RESULTS The mean age was 28 years with a clear female predominance (sex ratio 2.61). Ascites associated with fever were the most frequent signs found in 80.5% of patients. The ascitic fluid was exsudative in 90% of cases and lymphocytic in 88%. The diagnosis was based on laparoscopy or laparotomy with peritoneal biopsy demonstrating caseating granulomatous lesions in 92.4% of patients. Patients were given antituberculous therapy for 6 months, and the outcome was favourable in 90%. CONCLUSION Peritoneal tuberculosis is very frequent in Morocco, where the diagnosis is based exclusively on peritoneal biopsies obtained during laparoscopy. With an adapted treatment, the course of the disease is favourable in most cases.
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Affiliation(s)
- Mohammed El Abkari
- Service d'Hépato-Gastroentérologie, Hôpital Al Ghassani, CHU Hassan II, Fès, Maroc.
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Nguyen Duc C, Pha Hai B, Pham Van T, Ton That B, Huguier M. [Acute intestinal tuberculosis]. ANNALES DE CHIRURGIE 2006; 131:306-10. [PMID: 16545337 DOI: 10.1016/j.anchir.2006.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 01/25/2006] [Indexed: 05/07/2023]
Abstract
AIM OF STUDY To report cases from Vietnam of intestinal tuberculosis disease, which is uncommon but did not disappear in occidental countries. MATERIALS AND METHODS Seventy-six patients were included in this retrospective study. Mean age was 40 years and sex ratio M/F was 6. Diagnosis was established on pathological examination of resected specimen or on presence of Mycobacterium tuberculosis or by polymerase chain reaction. RESULTS Intestinal obstruction or subobstruction was the most usual symptom (68%), and thereafter peritoneal symptoms with pain and tenderness (17%). Five patients had intractable digestive haemorrhage. Thirty-six patients had no past history or active pulmonary tuberculosis (47%). Lesions of stenosis on barium enema and thickness of intestinal wall on CT-scan were not specific. Sixty-two patients were operated on (82%) and 14 were not. Surgical techniques differed according symptoms, site and type of lesions. Intestinal resections were performed in half of the patients, others undergoing stomies or enterolysis. There were eight postoperative deaths (13% of patients operated on), seven out of these deaths were attributable to cachexy. In the postoperative period, all the patients were medically treated and follow-up in the antituberculosis centre of Hanoi. CONCLUSION Symptomatology and operative findings of intestinal tuberculosis are similar to those observed in Crohn's disease, and sometimes in amoeboma or lymphoma. In face of stenosis and intestinal wall thickness, probability of intestinal tuberculosis is high in endemic area, but diagnosis must be suspected in occidental countries, mainly in patients immigrated coming from these areas, patients with immuno-deficiency even if they did not have past or present pulmonary tuberculosis.
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Affiliation(s)
- C Nguyen Duc
- Hôpital Viet-Duc, centre hospitalo-universitaire de Hanoi, Hanoi, Vietnam
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Gilroy D, Sherigar J. Concurrent small bowel lymphoma and mycobacterial infection: use of adenosine deaminase activity and polymerase chain reaction to facilitate rapid diagnosis and treatment. Eur J Gastroenterol Hepatol 2006; 18:305-7. [PMID: 16462547 DOI: 10.1097/00042737-200603000-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We describe the presentation and investigation of a rare case of small bowel lymphoma with concurrent abdominal tuberculosis, two diseases with similar findings at presentation, but very different treatments. We emphasize the importance of considering primary peritonitis in this context, and review current methods of rapid diagnosis of abdominal tuberculosis, which in this instance led to timely appropriate treatment.
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