Outcomes of Abdominal Tuberculosis Referred for Surgical Management in a Tertiary Care Center in Nepal

While abdominal tuberculosis (ATB) is a great masquerader, it can cause significant morbidity and mortality. We aim to evaluate the presentation and management outcomes of patients with abdominal TB referred to us for surgical management.

This is a retrospective study of patients with definitive or presumed ATB from January 2010 to July 2022 at a tertiary care hospital in Nepal. The data on clinical presentation, diagnosis, management, and short-term outcomes were analyzed.

Sixty-six patients with a definitive (25) and presumed (41) diagnosis of ATB were analyzed with a mean age of 32.6 years. Patients presented with moderate to severe anemia (57.1%), intestinal obstruction (53.0%), abdominal lump (30.3%), intestinal bleeding (4.5%), and peritonitis (27.3%) including intestinal perforation (6.1%). A total of 34 (51.5%) patients received surgical management. Intestinal obstruction was a significant risk factor for the need of surgery. Conservative management was successful in 37.1% and 31.3% of patients with intestinal obstruction and peritonitis respectively. Ileum and caecum were the most common sites of intestinal tuberculosis. Bowel resection and stoma were done in 13 (38.2%) and 10 (29.4%) patients respectively. There were 4 (6.1%) overall mortality including two operative mortalities. The common surgical complications were iatrogenic bowel injuries (13.1%), wound infection (32.3%), rectus sheath dehiscence (17.6%), and intra-abdominal abscess (14.7%). The median hospital stay was 8.5 days.

Surgical intervention in complicated ATB is associated with high morbidity and mortality. Judicious conservative management in ATB can be tried in selected patients.