ABDOMINAL TUBERCULOSIS D. Sidler, Paediatric Surgery, Tygerberg Children’s Hospital, SUN.
Abdominal Tuberculosis
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Transcript of Abdominal Tuberculosis
Abdominal TuberculosisAbdominal Tuberculosis
Dr. Irshad Ali Khan
PGT GST III
PIMS
EpidemiologyEpidemiology
Every year: 7-10 million new cases 6 % deaths
Abdominal T.B is the commonest extra pulmonary manifestation
Incidence in west in on rise due to Immigrants Aging HIV infection
Extra-pulmonary manifestations Non HIV patients: 10-15 % HIV patients: 50%
Re-emergence of the intestinal variant due to Incomplete therapy Multi drug resistance Increased incidence of HIV infection
Routes of abdominal KocksRoutes of abdominal Kocks
Direct Ingestion Infected sputum (M. tuberculosis) Dietary products e.g. unpasturised milk, M.
bovis) Haematogenous spread
Secondry to pulmonary TB Direct extension from the contiguous organ
e.g through fallopian tubes
PathogenesisPathogenesis
After ingestion the organism is trapped in the Peyer’s patches It undergoes inflammatory enlargementLeads to transverse mucosal ulcerationElement of endarteritis Ultimately may lead to bowel perforation
Mesenteric lymph node infectedEnlarge and caseate Intra abdominal abscess formation
PathogenesisPathogenesis
Fibrosis may follow leading to napkin ring strictures
Extensive inflammation of submucosa and subserosa at ICJ → hyperplastic form
Adjacent bowel loops, mesentery, and nodes adhere → a mass → intestinal cocoon
PathogenesisPathogenesis
Peritoneal involvement takes the form of the numerous tubercles on the peritoneum and intestine
Omentum thickens to form a rolled-up omentum
Ascites is usually present
PathogenesisPathogenesis
Haematogenous involvement presents as multiple parenchymal abcesses with organomegaly of the liver, spleen, and pancreas.
Contagious spread from the Spine Genitourinary tract Parietal wall Retro peritoneum
PeritonealPeritoneal Wet type: Ascites
Generalized Loculated
Dry plastic Mesenteric thickening Caseous lymph node Fibrous adhesions
PeritonealPeritoneal Fibrotic fixed type
Mass formation of the omentum Matting of the bowel loops
Acute primary peritonitis
Mesenteric Involvement Mass Abscess Nodal
Solid Organ
Liver, Spleen, Pancreas Localized abscess Multiple miliary form
Pre and post ATT Therapy