Abstract:

Objective To explore the effect of surgical treatment for abdominal tuberculosis complicated with intestinal perforation.Methods Forty-three abdominal tuberculosis patients complicated with intestinal perforation who underwent surgery in Hebei Chest Hospital from 2008 to 2016 were included in the study. All patients were suspected of lung tuberculosis by chest X-ray or CT scan. The clinical data were descriptively summarized and analyzed, including preoperative clinical manifestations, laboratory tests and examinations, intraoperative exploration and surgical procedures, postoperative treatment and complications, treatment outcome, and follow-up data.Results All of the 43 patients were confirmed as abdominal tuberculosis via postoperative pathology examination. Eighteen out of the 32 non-emergency patients were clinically diagnosed before surgery, whereas all of the 11 emergency patients were not diagnosed before operation. All patients had intestinal perforation confirmed by intraoperative exploration, of whom 3 cases were preoperatively diagnosed with intestinal obstruction, 30 cases were intestinal obstruction with intestinal perforation (8 emergency patients and 22 non-emergency patients were diagnosed with perforation by diagnostic puncture before operation), and 10 cases were intestinal perforation. Forty patients (93.0%) underwent stage I ileostomy due to a wide range of lesions, among whom, 12 patients with incision infection were cured after incision dressing and drainage; 2 of the 8 patients with intestinal fistula died of multiple organ failure (one received conservative treatment and one underwent secondary surgery; both >65 years old), and the remaining 6 cases had good outcome after treatment; 2 cases of intestinal obstruction were cured, one by secondary surgery and one by conservative treatment; and the remaining 18 patients recovered well after ileostomy. In addition, 2 cases (one with ileocecal mass with perforation and one with mild abdominal infection) underwent ileocecal resection and ileocolon anastomosis. One case underwent partial ileectomy and intestinal anastomosis due to a single perforation in the proximal ileocecal area, concurrent with abdominal lymph node tuberculosis and adhesion of local lymph node nodules and perforation site, but mild abdominal infection. No postoperative serious complications occurred in the patient. Anti-tuberculosis treatments were stopped after 12 months of treatment due to cure outcome. Thirty-seven patients were followed up for 18 to 24 months after treatment discontinuation, and 4 patients were lost to follow-up. During the follow-up period, 16 patients had intermittent mild abdominal pain, and others were generally in good condition. Conclusion Abdominal tuberculosis with intestinal perforation is a serious complication of tuberculous. On the basis of standard anti-tuberculosis drug treatments, surgery is the primary choice with good outcome.

Key words: Tuberculosis, gastrointestinal, Intestinal perforation, Surgical procedures, operative, Treatment outcome