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Published on: October 25, 2024
Diagnosis and treatment strategies of tuberculous intestinal perforations: a case series
Ming J Lee1, Fiona V Cresswell, Laurence John
1Faculty of Medicine, Imperial College London, London, UK. ming.lee06@imperial.ac.uk
Abstract:
Gastrointestinal tuberculosis (TB) may result in intestinal obstruction and perforation, even after antituberculous therapy has been initiated. Despite surgical intervention tuberculous perforation has a high complication and mortality rate, and it is difficult to predict the subgroup of patients with abdominal TB who progress to perforation. In this study, we retrospectively investigated the clinical features that may predict disease progression in patients in our institution who presented abdominal TB over a 5-year period between January 2006 and August 2011, as well as describe an unreported method of managing tuberculous intestinal perforations when resection with end-to-end anastomosis is unfeasible. Six out of 91 patients (6.6%) with abdominal TB developed perforations. Factors linked with increased complications and mortality were age, comorbidities, multiple perforations and length of time between onset of abdominal symptoms and perforation. Four patients (66.7%) had long histories of abdominal symptoms before perforation. Three patients were receiving or had completed antituberculous therapy before developing perforation. Five patients were managed surgically, two underwent laparostomy as both primary closure and end-to-end anastomosis were deemed too risky. Mortality following perforation was 17%. Patients with prolonged abdominal symptoms, even after antituberculous therapy, should raise suspicion for subacute intestinal obstruction. This should be recognized early and surgical intervention considered in order to prevent mortality secondary to perforation. Laparostomy may be an alternative when resection and end-to-end anastomosis is not possible.
Insights
Gastrointestinal tuberculosis (TB) can cause intestinal perforation, even during treatment. Prolonged symptoms warrant early surgical evaluation to prevent fatal complications, with laparostomy as a viable surgical option.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Oncology
Background:
- Gastrointestinal tuberculosis (GITB) poses risks of intestinal obstruction and perforation, persisting even with antituberculous therapy.
- Predicting which abdominal TB patients will develop perforation is challenging, despite high complication and mortality rates post-surgery.
Purpose of the Study:
- To retrospectively identify clinical predictors of disease progression in abdominal TB patients.
- To describe an alternative management strategy for tuberculous intestinal perforations when standard surgical options are unfeasible.
Main Methods:
- Retrospective investigation of clinical features in 91 abdominal TB patients over a 5-year period (January 2006 - August 2011).
- Analysis of factors associated with complications and mortality in patients who developed perforation.
- Evaluation of surgical management, including laparostomy, for tuberculous intestinal perforations.
Main Results:
- Six out of 91 patients (6.6%) with abdominal TB developed perforations.
- Increased complications and mortality were linked to age, comorbidities, multiple perforations, and delayed presentation.
- Four patients (66.7%) had a history of prolonged abdominal symptoms before perforation; three had received antituberculous therapy.
- Laparostomy was used in two patients due to high surgical risks associated with resection and anastomosis.
- Mortality rate following perforation was 17%.
Conclusions:
- Prolonged abdominal symptoms in patients with GITB, even after antituberculous therapy, suggest subacute intestinal obstruction and necessitate early surgical consideration.
- Prompt recognition and surgical intervention are crucial to prevent mortality from tuberculous intestinal perforation.
- Laparostomy presents a viable alternative for managing tuberculous intestinal perforations when resection with end-to-end anastomosis is not feasible.
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