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Spontaneous tuberculous enteroumbilical fistulas
Insights
Gastrointestinal tuberculosis in children, though rare, can cause enteroumbilical fistulas. Conservative management with antitubercular drugs showed better survival rates than surgical intervention for these rare pediatric cases.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Surgical Pediatrics
Background:
- Gastrointestinal tuberculosis (GITB) is uncommon in children.
- Common complications of tuberculous enteritis include obstruction and hemorrhage.
- Tubercular enterocutaneous fistula is a rare complication of GITB.
Observation:
- This report details five pediatric cases of spontaneous tubercular enteroumbilical fistulas.
- All patients were under 10 years old, with the youngest being 15 months.
- Four children received conservative treatment with antitubercular drugs.
- One child underwent surgical intervention (exploration, resection, and excision).
Findings:
- Conservative management led to survival in all four treated children.
- The child who underwent surgery died postoperatively.
- This suggests a significant difference in outcomes between treatment modalities.
Implications:
- Conservative management with antitubercular drugs appears to be the preferred treatment for established tubercular enterocutaneous fistulas in children.
- Further research may be warranted to confirm optimal management strategies for this rare pediatric condition.
Abstract:
Gastrointestinal tuberculosis in children is an uncommon condition. Obstruction and hemorrhage are the known common complications of tuberculous enteritis. Perforation is an uncommon complication whereas tubercular enterocutaneous fistula is a still rarer complication. Five children with spontaneous tubercular enteroumbilical fistulas are being reported. All were below the age of 10 years, the youngest being 15 months old. Four children had conservative treatment with antitubercular drugs and one had exploration, resection of gut and excision of fistula. All the children who had conservative treatment survived whereas the child who underwent surgery died in the postoperative period. We feel that the conservative management is the treatment of choice in cases of established tubercular enterocutaneous fistulas.