Case series of acute presentation of abdominal TB in Ghana

We report on a six-year prospective study to determine the presentation and outcome of acute abdominal TB at Komfo Anokye Teaching Hospital. Between January 1998 and December 2003, material for biopsy including resected bowel was taken from all cases of acute abdomen, which at laparotomy were suspected as one or other form of abdominal TB. TB-positive cases were then retrospectively analysed for clinical presentation and outcome of surgical treatment. There were 96 histologically proven cases of abdominal TB, 60 in women and 36 in men. Seventy patients (72.9%) were admitted as acute intestinal obstruction with acute abdominal pain, vomiting, constipation, distension and fluid levels on abdominal X-ray. Twenty-two (22.9%) patients were admitted as acute diffused peritonitis - with generalized abdominal tenderness, guarding and rebound - and four (4.2%) as acute appendicitis. There were 74 emergency bowel resections (77% resection rate) for 34 ileocaecal masses, 16 strictures, 10 perforations and 14 adhesions, with a mortality of 4.2%. Previous series from our subregion have reported similar emergency resection mortality rates for other abdominal conditions. All the patients received postoperative anti-TB therapy. This paper notes that acute intestinal obstruction is the most common acute presentation of abdominal TB in our environment. The results of emergency resection compare favourably with resection for other acute abdominal conditions.