Abdominal tb interesting case

1. AN INTRIGUING CASE SERIES ON
INTESTINAL OBSTRUCTION IN
TB ABDOMEN - WHEN AND
WHEN NOT TO OPEN
UNIT S1

2. CASE 1
• 55/F presented with diffuse abdominal pain x 1 day
• H/o Constipation +
• H/o Obstipation +
• Prior H/o 2LSCS
• K/c/o Hypothyroid/T2DM on Treatment

3. • O/E :
Vitals Stable, General condition fair
, Abdomen distended.
Diffuse tenderness +
No guarding/rigidity
Lower midline scar +
Pffanensteil scar
No Visible peristalisis
Bowel Sounds Hyperdynamic
DRE : Fecal staining +

4. • Investigations - CBC. S.electrolytes,RFT normal
• CXR - Normal
• CECT ABdomen -
Small bowel loops were dilated with air fluid level with maximum
diameter of 3.8 cm. Proximal ileum was the cut off point. Distal loops
collapsed.

6. • The patient was diagnosed as a case of adhesive intestinal obstruction
and was planned for Emergency Laparatomy

7. • INTRAOPERATIVE FINDINGS :
Cocoon abdomen noted.
Dense adhesions 100 cm from dj flexure till 100 cm from the IC
Junction - Toal 200cm
Multiple fecoliths in the appendix
P/D - Emergency laparatomy with adhesiolysis and appendicectomy

9. • Post Op HPE ( Appendix and peritoneum): Chronic Infammatory
pathology.
• Postoperatively the patient was started on Empirical ATT -
• Postoperative period uneventful

10. CASE 2
• 48/F presented with diffuse abdominal pain and multiple episodes
vommiting x 6months aggravated 2 months.
• H/o Constipation +
• No H/o Obstipation
• H/o Cough, low grade fever on and off x 6 months
• H/o loss of weight/loss of appetite
• Diagnosed as a case of extrapulmonary TB and started on ATT 2
months back , following which the symptoms worsened.

11. • O/E
• Patient drowsy, dehydrated, pale, poorly built
• Abdomen was distended, Visible intestinal peristalisis +
• Diffusely tender
• No guarding/rigidity
• BS were hyperdynamic
• DRE - No fecal staining.

12. • Investigations
• CBC - Anemia, thrombocytopenia
• Severe Hypokalemia (K - 1.7)
CECT Abdomen Pelvis
Small bowel loops dilated with maximum 3.6 cm, mid ileum was the
transition point.
Diagnosis - TB Abdomen with super imposed Paralytic ileus due to
Hypokalemia

13. • Plan - Conservative Line of Management with Correction of
Hypokalemia as the Aim.
• Progress :
iv potassium correction was given, following which the potassium level
was transiently corrected. At this stage the patient passed stools and
DRE revealed fecal staining.
The patient developed Hypokalemia now refractory to treatment and
developed cardiac arrest as a result of Hypokalemia.

14. TAKE HOME MESSAGE
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.