Aira Hospital

Uncomplicated abdominal TBC is usually diagnosed by the clinical picture with abdominal pain, often slight distension and/or ascites with very high ESR (above 100), normal or slightly elevated WBC with lymphocytosis. Ultrasound scanning is not very useful except in expert hands.

When presenting as an acute abdomen with peritonitis or obstruction the diagnosis is made by laparotomy. Milliary seeds or caseating lymph nodes are sure signs of tuberculosis.

Milliary seeds	Milliary seeds

 

Enlarged mesenteric lymph nodes	…….with caseation

 

Often the intestines are severely matted together and releasing the obstruction can be extremely difficult and hazardous – sometimes impossible. A simple bypass can get you out of the trouble:

Identify a loop of collapsed bowel and a loop of dilated bowel – make a side-to-side anastomosis between the two loops.

 

Ileocecal resection is the best option for coecal TBC, but if it is technically difficult an ileotransverse bypass might be a better option.

Here is an example of a side-to-side ileotransverse anastomosis in one layer with a continuous suture.

Ileocecal TBC	Ileum and transverse colon clamped
… and approached to each other	Lumina are cut opened
Inner layer of continuous suture started	Inner layer continued
Inner layer continued	Outer layer in progress
Anastomosis completed …….	……and tested for leakage

 

Anti TBC drugs are started as soon as the patient is able to take oral feedings.