Abstract

ABSTRACT:
BACKGROUND:
The aim of this study is to present our experience in the management of gastrointestinal tuberculosis in Iraq.
PATIENTS&METHODS:
86 cases with intestinal tuberculosis were histologically proven by endoscopy or surgery, during the period 1965-2004 at the Medical City Teaching Hospital, & two private hospitals (Alousi & Mustansiria), Baghdad.
RESULTS:
54(62.8%) were female and 32(37.2%) were male. Age ranged from 6-82 years (mean 33yrs), peak 30-39 years. Clinical presentation were; intestinal obstruction 44(51.2%), abdominal mass 20(23.3%), malabsorption 13(13%), massive gastrointestinal bleeding 3(3.5%), peritonitis 3(3.5%), pyloric obstruction 2(2.3%) and dysphagia 1(1.2%) patients. Chest X-ray reported; normal in 62(72.1%), active pulmonary tuberculosis in 3(3.5%), and healed lesion in 21(24.4%) patients. Barium study revealed dilated bowel loops in 31(45.6%); other less frequent findings were strictures, filling defect, shortening and bowel irregularity. OGD showed a significant pathology in 7 out of 11 patients examined. Ultrasound showed helpful imaging modality in 15/21 patients; ascitis, masses, enlarged lymph nodes, and thick bowel loops in some cases. Site of lesions were; ileocecal 42(48.8%), small bowel 33(38.4%), colorectal 8(9.3%) and stomach 3(3.5%) patients. Gross appearance were hyperplastic 33(38.4%), ulcerative 20(13.9%), strictures 21(24.4), and mixed 12 (13.9%) patients. Surgical procedures were; right hemicolectomy 38(44.2%), resection of small bowel 23(26.7%), colectomy 4(4.7%), by-pass 4(4.7%), stricturoplasty 2(2.3%), and subtotal gastrectomy 1(1.2%) and biopsy only 14(16.3%) patients. One patient died post-operatively from pulmonary embolism, 6 lost to follow, 4 had relapse after stopped treatment within 3-5 months (one of them died from intestinal obstruction) while the result in those followed 74 (including 3 who relapsed and re-treated) patients whom received chemotherapy for over one year were very satisfactory.
CONCLUSION:
Gastrointestinal tuberculosis affects females more than males. No age is immune, peak in 3rd decade. Symptomatology is non-specific, it should be suspected in patients having abdominal pain, weight loss, anorexia, fever, ascites and abdominal mass. Sub-acute or acute intestinal obstruction is the most common presentation followed by abdominal mass or malabsorption in our study. Normal chest radiograph does not exclude the presence of abdominal tuberculosis, but it should be suspected in high ESR patients. Surgical interventions is not alternative to standard anti-tuberculous therapy