scholarly journals Surgical management of abdominal tuberculosis in a tertiary care referral center

2020 ◽  
Vol 7 (3) ◽  
pp. 842
Author(s):  
Subramaniam Swaminathan ◽  
C. S. Naidu ◽  
P. P. Rao
Keyword(s):  
Surgical Management ◽  
Diagnostic Laparoscopy ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Barium Meal ◽  
Diagnostic Procedures ◽  
Exploratory Laparotomy ◽  
Abdominal Tuberculosis ◽  
Final Diagnosis ◽  
Definitive Management

Background: Abdominal tuberculosis encompasses gastrointestinal, visceral and peritoneal forms of tuberculosis in different proportions. Their clinical presentation and radiological findings are varied and non-specific often warranting surgical intervention either for confirmation of diagnosis or for definitive management.  It is not very clear as of now as to which type of patients would require surgical intervention for diagnosis or treatment of abdominal tuberculosis. This study aims to profile such patients accurately to revalidate the need for surgical intervention in cases of abdominal tuberculosis.Methods: This study is a retrospective descriptive observational study wherein the documents of patients whose final diagnosis was confirmed as ‘Abdominal Tuberculosis’ from January 2011 to December 2013 were analysed. Their demographic and clinical profile, hematological, biochemical and radiological investigations including barium meal follow-through, ultrasonography, CT scan abdomen, colonoscopy and biopsy, HIV status and ascitic fluid analysis were analysed. Patients in whom diagnosis was not confirmed by these investigations, and therefore underwent diagnostic laparoscopy or exploratory laparotomy were studied. Simultaneously, patients in whom, the diagnosis was confirmed, but still underwent surgical intervention for therapeutic purposes were also analysed.Results: It was found that 44 out of 54 patients (81.4%) underwent surgical procedure.  28 (52%) required surgical intervention for confirmation of diagnosis (diagnostic procedures: diagnostic laparoscopy- 21 and exploratory laparotomy- 07) while 16 (29.4%) required therapeutic procedures (emergency- 08; elective- 08).Conclusions: In spite of extensive investigations, many patients of abdominal tuberculosis require surgical management either minimally invasive or otherwise, both for confirmation of diagnosis and for definitive management.

scholarly journals A STUDY OF INTESTINAL OBSTRUCTION CONSERVTIVE VERSUS SURGICAL MANAGEMENT

2020 ◽  
Vol 1 (2) ◽  
pp. 10-16
Author(s):  
MA Oyinlola ◽  
OA Omisakin
Keyword(s):  
Abdominal Surgery ◽  
Intestinal Obstruction ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Exploratory Laparotomy ◽  
Related Factors ◽  
Previous Abdominal Surgery ◽  
Intestinal Contents ◽  
History Of ◽  
Obstructed Hernia

Intestinal obstruction refers to the impairment to the abnormal passage of intestinal contents which can be due to the mechanical obstruction or failure of normal intestinal motility in the absence of an obstructing lesion. Extra luminal, intrinsic, and intraluminal are three categories of small bowel obstruction. In this retrospective observational study, patients presenting to the A&E department of surgery unit who had similar condition were screened. The study is based on total of 60 patients out of which 22 patients managed conservatively whereas 38 patients were managed surgically. Common symptoms were abdominal pain and vomiting. 20 patients had previous abdominal surgery; 16 had exploratory laparotomy for abdominal trauma, perforation, gynae procedure, etc. 4 patients developed characteristic of obstruction following laproscopic. 14 patients undergone surgery while 6 patients were managed conservatively. Surgically managed duration was 2.8 days on average. Mean duration for conservatively managed patients was 2.9 days. Among the surgically managed patients, 11 had strictures, 14 had adhesion, 8 had obstructed hernia, 1 had intussusception, and 4 had abdominal TB. Based on the cause of the obstruction, surgical procedure was carried out. History of abdominal surgery was found to be more frequent in whom obstruction was relieved conservatively. The conclusion of the study is that adhesions based on previously conducted surgery are important causes of SBO. Two common method of managing the condition is conservative management and surgical management. The criteria for utilizing particular method is based on several patient related factors. Clinical decisions guide the management of SBO and timing of surgical intervention.

scholarly journals A CLINICAL PRESENTATION AND SURGICAL MANAGEMENT OF ABDOMINAL TUBERCULOSIS AT IMCHRC, INDORE

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Dr. Anil Kumar Baxi ◽  
Dr. Vasant Dakwale ◽  
Dr. Namrata Mishra
Keyword(s):  
Observational Study ◽  
Acute Abdomen ◽  
Surgical Management ◽  
Prospective Observational Study ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Abdominal Tuberculosis ◽  
Acute Presentation ◽  
Different Types

Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to concerned clinical presentation & surgical management. The study also discusses the indications and extent of surgical intervention. Keywords: Surgical, Abdominal & Tuberculosis.

scholarly journals Abdominal tuberculosis: a surgical emergency

2017 ◽  
Vol 5 (9) ◽  
pp. 3847
Author(s):  
Rajandeep Singh Bali ◽  
Rahul Jain ◽  
Yawar Zahoor ◽  
Ankul Mittal
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Acute Intestinal Obstruction ◽  
Care Hospital ◽  
Number Of Patients ◽  
Management Protocol ◽  
Operative Findings

Background: To study and assess the clinico-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality of the patients included in the study group.Methods: This study was carried out at Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, a tertiary care hospital between November 2011 to March 2015. It was a retrospective study in which the records of the patients operated upon in the emergency department as peritonitis or acute intestinal obstruction and whose diagnosis was later confirmed as tuberculosis on histopathology were analysed with regards clinic-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality.Results: The mean age of our study group was 28.7 years. 70% of our patients were found to be in the underweight category and 30% were in the normal category. Fourty three (56.6%) presented to the hospital with features suggestive of peritonitis and thirty-three (43.4) were suffering from acute intestinal obstruction. The commonest intra-operative finding encountered was ileal perforation followed by multiple small bowel perforations, solitary stricture of the small bowel with perforation, ileo-cecal mass, adhesions or bands, single or multiple strictures, stricture with impending small bowel perforation and jejunal perforation. The frequently performed surgical procedures were ilesotomy, resection and anastamosis of the involved bowel, primary repair of thr perforation, right hemicolectomy, adhesiolysis, stricturoplasty (done in case of single stricture, mostly), jejunostomy and peritoneal and omental biopsy.Conclusions: Tuberculosis is a very grave disease, studies with larger number of patients need to be conducted to standardise its surgical management as at present there is no standardised surgical management protocol.

scholarly journals Evaluation of efficacy of laparoscopy in patients with chronic abdominal pain

2017 ◽  
Vol 4 (6) ◽  
pp. 1856
Author(s):  
Sanjay Prasad ◽  
Suraj Jain ◽  
Advait Prakash ◽  
Ajeet Gautam ◽  
Mohan Gadodia ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Psoas Abscess ◽  
Demographic Data ◽  
Tertiary Care ◽  
Cost Effective ◽  
Abdominal Tuberculosis ◽  
Pelvic Abscess ◽  
Chronic Abdominal Pain ◽  
Chronic Appendicitis

Background: Chronic abdominal pain is a major cause of surgical dilemma. Patients with chronic abdominal pain usually undergo a battery of investigations without yielding much in diagnosis. The pain in such patients therefore becomes chronic and perpetual source of discomfort. This study was under taken to assess the efficacy of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 3 weeks or more.Methods: This prospective study was performed at a tertiary care level hospital. All patients undergoing laparoscopy for chronic abdominal pain were included in the study from December 2013 to June 2015. The patient’s demographic data, duration of pain, diagnostic studies, intra-operative findings during laparoscopy, interventions performed and follow-up were recorded and evaluated.Results: A total of 50 patients, 22 females and 28 males, between age range of 10 years to 60 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average duration with pain was 10.38 weeks (range 4-32 weeks). Findings included abdomen chronic appendicitis in 15 patients, abdominal tuberculosis in 11 patients, ovarian cyst five patients, sub acute intestinal obstruction in five patients and liver abscess four patients. Meckel’s diverticulum, ectopic pregnancy, pelvic abscess, appendicular lump, Psoas abscess and typhilitis were noted in one patient each. Various procedures in accordance with pathology were performed. 92% of patients had pain relief at the time of follow up.Conclusions: Diagnostic laparoscopy is a better, cost-effective, and efficient method of establishing the diagnosis in patients with chronic abdominal pain.

scholarly journals A prospective study of surgical management of Koch’s abdomen in a tertiary care hospital

2021 ◽  
Author(s):  
Archana Shukla ◽  
Rajpal Kori ◽  
Rahul Shivhare ◽  
Lalit Dhurve ◽  
Sonveer Gautam
Keyword(s):  
Prospective Study ◽  
Surgical Management ◽  
Communicable Disease ◽  
Tertiary Care ◽  
Age Groups ◽  
Abdominal Tuberculosis ◽  
Morbidity And Mortality ◽  
Common Finding ◽  
Diagnostic Tools ◽  
Care Hospital

Background: Tuberculosis is a communicable disease that is a major cause of morbidity and mortality worldwide. Abdominal tuberculosis is the sixth most common form and is associated with serious complications like perforation and stricture formation.Methods: Observational and prospective study conducted in Hamidia Hospital, Bhopal from September 2018 to September 2020 included 122 patients, between the age of 16 to 60 years who underwent surgical management of abdominal tuberculosis.Results: The incidence of abdominal tuberculosis was higher in young age groups mostly belonging to male sex. The most common presentation was of subacute intestinal obstruction. On surgical exploration ileocecal tuberculosis was the most common finding which was managed most commonly by segmental resection with anastomosis followed by adhesiolysis and strictureplasty. Post-operative wound infection was the most common complication followed by pulmonary complication which was the most common cause of death.Conclusions: Early diagnosis of abdominal tuberculosis with the help of newer diagnostic tools and early referral to higher centers is necessary to decrease the morbidity and mortality. Early start of anti-tubercular drug therapy along with surgical management can help us reduce the mortality and long-term complications associated with abdominal tuberculosis.

scholarly journals The role of diagnostic laparoscopy in the era of modern imaging techniques: a study from a single center

2019 ◽  
Vol 6 (5) ◽  
pp. 1578
Author(s):  
Muzafar Yousuf Parray ◽  
Ajaz Ahmad Malik ◽  
Yaqoob Hassan ◽  
Ishfaq Ahmad Wani ◽  
Munir Ahmad Ahmad Wani ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Liver Disease ◽  
Diagnostic Laparoscopy ◽  
Abdominal Tuberculosis ◽  
Final Diagnosis ◽  
Diffuse Liver Disease ◽  
Chronic Appendicitis ◽  
Focal Liver Disease ◽  
Abdominal Malignancy

Background: Despite the tremendous progressive evolution in the field of medicine, wherein, most of the diseases can be diagnosed based on history, clinical examination and investigations, there are quite a number of diseases which remain undiagnosed. It is here, where the role of diagnostic laparoscopy becomes important to reach to a conclusion for further management of patients.Methods: This study comprising of 70 patients undergoing diagnostic laparoscopy at SKIMS over a period of 4 years. This study was done to evaluate the role of diagnostic laparoscopy in patients with acute and chronic abdominal conditions wherein final diagnosis could not be achieved after all necessary imaging, serological, cytological, and microbiological investigations.Results: Out of 70 patients subjected to diagnostic laparoscopy in our study, the commonest indication was as cites of undetermined etiology (42.9%) followed by chronic abdominal pain (25.7%) diffuse liver disease (11.4%) acute abdominal pain (SAIO, cholecystitis, acute appendicitis, PID, endometriosis) (5.7%) abdominal tuberculosis (4.3%) focal liver disease (2.9%) bleeding per rectum (2.9%) abdominal malignancy (2.9%) and primary infertility (1.4)%. The post diagnostic laparoscopy outcome (final diagnosis) were abdominal malignancy 22 (31.4%) followed by abdominal tuberculosis 16 (22.9%) diffuse liver disease 6 (8.6%) focal liver disease 6 (8.6%) PID 4 (5.7%) SAIO 4 (5.7%) post-operative pelvic adhesions 3 (4.3%) Meckel’s diverticulum 2 (2.9%) abdominal plus pulmonary tuberculosis 1 (1.4%), endometriosis 1 (1.4%), ovarian cyst 1 (1.4%), pseudomyxoma peritonei 1 (1.4%), chronic appendicitis 1 (1.4%) and inconclusive 2 (2.9%). Diagnostic laparoscopy confirmed pre-operative diagnosis in 10 (14.3%) patients. In 29 (41.4%) patients pre-operative diagnosis was corrected by diagnostic laparoscopy. In 29 (41.4%) patients diagnosis was made only after diagnostic laparoscopy.Conclusions: Diagnostic laparoscopy is a safe, quick, and effective adjunct to non surgical diagnostic modalities, for establishing a conclusive diagnosis with high percentage of accuracy in diagnosis and impact in further management in selected patients.

scholarly journals Koch's abdomen- management of surgical complications and outcomes at a remote hill area tertiary care center

2019 ◽  
Vol 6 (5) ◽  
pp. 1514
Author(s):  
Amit Keshri ◽  
Anil Kumar ◽  
Sanjeev Prakash ◽  
Khem Pal Singh
Keyword(s):  
Wound Closure ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
Abdominal Tuberculosis ◽  
Adverse Outcomes ◽  
Age Group ◽  
Modes Of Presentation ◽  
Hill Area ◽  
Prolene Suture

Background: Abdominal tuberculosis needs surgical intervention in a subset of patients; both in emergency and elective settings, requiring surgeons to be familiar with its varied and non-specific modes of presentation and their diagnosis and management.Methods: Patients of abdominal tuberculosis, having undergone surgical management at our Institute, VCSGGMS&RI-UT, between April 2015 to March 2019, numbering eighty (n= 80), were included in this concurrent observational study.Results: Middle age-group patients (20-50 years; 56.3%) with a male majority (73.8%) predominated. Reinfection/ relapse of tuberculosis infection might occur despite BCG immunisation (46.3%) and course of ATT (16.3%); complications like bowel obstruction (28; 35%), perforation etc. need laparotomy to effect relief, with stomy formation required (51.3%) frequently; inadequate recovery warranting a secondary/re-look laparotomy (15; 18.8%). Prolene suture for abdominal wound closure is advantageous with a lesser rate of complications and incisional hernia. Septicemia, multi-organ dysfunction, wound infection should be aggressively managed to prevent adverse outcomes, including death (10; 12.5%).Conclusions: Adequate, intensive and timely surgical intervention/laparotomy, with nutritional support, stomy care and concurrent ATT can result in prompt relief and speedy recovery of patients with abdominal tuberculosis.

scholarly journals Frequency of Incidental Findings on Diagnostic Laparoscopy in Patients Undergoing Elective Laparoscopic Cholecystectomy

2021 ◽  
pp. 227-231
Author(s):  
Nazia Khatoon Soomro ◽  
Sandesh Kumar ◽  
Karim Bux Bhurgri ◽  
Ahmed Hussain Pathan ◽  
Altaf Ahmed Talpur
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incidental Findings ◽  
Diagnostic Laparoscopy ◽  
Tertiary Care ◽  
Exploratory Laparotomy ◽  
Chronically Ill ◽  
Surgical Trauma ◽  
Care Hospital ◽  
Cross Sectional ◽  
Elective Laparoscopic Cholecystectomy

Objective: To determine the frequency of incidental findings on diagnostic laparoscopy in patients undergoing elective laparoscopic cholecystectomy at tertiary care hospital Jamshoro. Study design: This is a descriptive cross sectional study. Setting: Study carried out at department of general surgery, Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro from 1st February 2019 to 30th July 2019. Materials and methods: A total of 164 patients of both gender undergoing diagnostic laparoscopy in patients of laparoscopic cholecystectomy were included in the study. Laparoscopy was done under general anesthesia in all patients. The whole of peritoneal cavity was sequentially                 visualized using trendelenberg and reverse trendelenberg positions, and right or left tilt as      required. Results: Age range in this study was from 20 to 79 years with mean age of 43.622±9.31 years. 40.2% patients were of male gender and 59.8% patients were females. Peritoneal band & adhesions was seen in 9.8% patients, Ovarian Cyst 5.5%, Abdominal Tuberculosis 19.5% and Gall Bladder Carcinoma was 3%. Conclusion: We conclude that laparoscopy is very safe, can obviate the need for a full exploratory laparotomy & minimize the surgical trauma in chronically ill patients.

scholarly journals Implications of discrepancy in morphologic diagnosis of myelodysplastic syndrome between referral and tertiary care centers

Blood ◽  
2011 ◽  
Vol 118 (17) ◽  
pp. 4690-4693 ◽  
Author(s):  
Kiran Naqvi ◽  
Elias Jabbour ◽  
Carlos Bueso-Ramos ◽  
Sherry Pierce ◽  
Gautam Borthakur ◽  
...  
Keyword(s):  
Myelodysplastic Syndrome ◽  
Tertiary Care ◽  
Diagnostic Procedures ◽  
Final Diagnosis ◽  
International Prognostic Scoring System ◽  
Cancer Center ◽  
Clinical Implications ◽  
Tertiary Center ◽  
Tertiary Care Centers ◽  
French American British

Abstract Patients referred to tertiary care centers occasionally may have their diagnostic procedures repeated and have a final diagnosis that differs from that of the referring center. The aim of this study was to evaluate discordance rates and their clinical implications in the diagnosis of patients with myelodysplastic syndrome (MDS) referred to a tertiary center. We analyzed 915 patients with MDS who were referred to M. D. Anderson Cancer Center between September 2005 and December 2009. Discordance in the diagnosis was documented in 109 (12%) patients, with a majority reclassified as having higher-risk disease by French-American-British (67%) or by International Prognostic Scoring System (77%) with implications for therapy selection and prognosis calculation. These results demonstrate the complexity of the diagnosis of MDS and highlight the need for confirmation of diagnosis when in doubt.

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