TNASICON CVA (final.pptx

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1. AN INTRIGUING CASE SERIES ON INTESTINAL OBSTRUCTION IN TB ABDOMEN - WHEN AND WHEN NOT TO OPEN Presenting author: Dr . C.V.Aruneshwar , Post graduate Guide : Prof . Dr. S.P. Gayathre MS, DGO Govt . Stanley Medical college and Hospital Introduction : The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB) Imaging modalities guide the line of evaluation Polymerase chain reaction-based tests (e.g. Xpert Mtb /Rif) have low sensitivity. Ascitic adenosine deaminase and histological clues provide specificity to diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered especially in TB-endemic regions. Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for early response assessment and should be sought at two months. For most forms of abdominal tuberculosis, six months of ATT is sufficient.  

2. O/E Vitals stable, GC Fair Abdomen distended with diffuse tenderness. BS Hyperdynamic . DRE: Faecal staining + Blood Panel – Normal CXR - Normal CECT Abdomen Pelvis : Dilated small bowel loos with air fluid level with maximum diameter of 3.8 cm with the proximal ileum as the cutoff point and collapsed distal ileum. Case capsule: #1 55/F - Diffuse abdominal pain H/o not having passed stools or flatus K/c/o Hypothyroid, Underwent 2 LSCS Fig 1. Cocoon Abdomen HPE : Chronic Inflammatory Pathology Procedure : Emergency laparatomy carried out. Cocoon abdomen was noted with dense adhesions extending from a point 100cm from the Duodenojejunal flexure till a point 100 cm from the ileocaecal junction, for a total length of 200 cm. Adhesiolysis carried out. Fig 2. Post adhesiolysis Case capsule: #2 48/F , k/c/o EPTB on Rx - Diffuse abdominal pain, constipation ,vomiting x 6 months, aggaravated since initiating ATT. O/E Dehydrated, drowsy, pale, poor built Abdomen distended with diffuse tenderness and visible peristalisis . BS Hyperdynamic . DRE: Faecal staining + Blood Panel – Anaemia , thrombocytpenia,Hypokalemia CECT Abdomen Pelvis : Dilated small bowel loops with a maximum diameter of 3.6 cm with mid ileum as the transition point. Management : Diagnosed as a case of Subacute small bowel obstruction with superimposed hypokalemia leading to paralytic ileus . Conservative management initiated with correction of hypokalemia as aim. After Initiating IV K correction, K levels were transiently corrected – Normal bowel sounds ensued and patient passed stools. Patient developed refractory hypokalemia afterwards and as a result of which developed cardiac arrest.

3. Discussion:   Discussion: Abdominal TB is an infection of the gastrointestinal tract, peritoneum, solid abdominal viscera, or abdominal lymphatics with M. tuberculosis [1]. Risk factors include cirrhosis, HIV, diabetes, malignancy, chemotherapy, and peritoneal dialysis. Abdominal TB is noted for its varied clinical presentation. It can mimic many clinical gastrointestinal conditions, presenting as acute, chronic, acute-on-chronic, or even incidentally.Abdominal TB poses a considerable diagnostic challenge due to nonspecific symptoms, diagnostics, and findings. Laboratory investigations are nonspecific and unhelpful in the diagnosis of abdominal TB. A high index of suspicion is required, and diagnosis chiefly relies on strong clinical suspicion and aggressive investigation. The mainstay of treatment is medical therapy though timely surgical intervention is required in a sizable number of patients. Not all cases of Inestinal Obstruction in TB abdomen have mechanical obstructive cause. As with the second case, it can be due to super impostion of paralytic ileus on a subacute obstruction. Thus Operative management is not routinely warranted. References World Health Organization. Global Tuberculosis Report 2018. Geneva: World Health Organization; 2018. 2. Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World J Gastroenterol . 2014;20:14831–40.] 3. Singh H, Krishnamurthy G, Rajendran J, Sharma V, Mandavdhare H, Kumar H, et al. Surgery for abdominal tuberculosis in the present Era: Experience from a tertiary-care center. Surg Infect ( Larchmt ) 2018;19:640–5.