Abdominal tuberculosis requiring surgical intervention: A 10-year single-center experience

Abstract

Background: Although uncommon in children, abdominal tuberculosis (ATB) can be a life-threatening condition with a subset requiring emergency surgical intervention.  This study aims to determine the presentation, surgical procedures performed, and outcomes in children affected by abdominal tuberculosis. Methods: A retrospective chart review of all children undergoing surgical intervention for ATB from July 2007 to December 2018 was conducted. Data were analyzed using SPSS version 22. Results: Of 340 children with a diagnosis of ATB seen at the Indus Hospital’s TB clinic, 14 (4%) underwent laparotomy. Females were affected more commonly (57%), with a mean age at presentation of 11 years (range 8-14). Nine children required laparotomy for documented perforation, while 5 had an intestinal obstruction. Most children (n=10) had an established diagnosis of ATB before the surgical intervention; 2 children had completed 6–9 months anti-tuberculous treatment (ATT) courses, while 8 children had been on ATT for a mean period of 2.5 months at the time of developing acute surgical symptoms.  Diversion ileostomy was made in 64%.  Postoperative complications included sepsis (n=4), wound infection (n=3), abdominal collection (n=2), enterocutaneous fistula (n=2), and abdominal wound dehiscence requiring formal closure (n=2). There were 4 mortalities (29%); 10 patients were discharged after a median in-hospital stay of 12 days (range 6-35) of which 6 with ileostomies underwent reversal after completion of the ATT course. Conclusion: ATB has high morbidity and mortality. Perforation and obstruction can occur during or after the completion of ATT.  Management requires early recognition and surgical intervention as indicated.