[The clinical picture and diagnosis of complicated forms of abdominal tuberculosis].

Abstract

The paper presents the diagnostic features of 95 cases with complicated forms of abdominal tuberculosis (AT). The latter has been found to be concurrent with disseminated progressive pulmonary tuberculosis in 97.3% of cases. HIV infection is present in 25.2% of the patients. In 42.1%, a complication of AT is its first onset. The late diagnosis of AT in the phase of development of complications is due to its asymptomatic course at the early stage, the similarity of clinical manifestations with various nonspecific abdominal diseases, the low informative value of radiodiagnostic techniques, and scanty bacterial excretion. In this connection, AT is detectable in 92.6% with the development of acute surgical abdominal pathology requiring emergency diagnostic laparoscopy and surgery. Among all acute surgical abdominal diseases, complicated abdominal tuberculosis ranks third, which in the presence of any abdominal symptoms, particularly those concurrent with pulmonary tuberculosis needs examination for abdominal tuberculosis. Various surgical interventions (more commonly right-sided hemicolectomy, enterectomy, and abdominal abscess lancing) were made in 92 patients with complicated abdominal tuberculosis. There were intraoperative complications, such as perforated tuberculous intestinal ulcers (54.7%), ileus (30.5), abdominal and retroperitoneal abscesses (11.6%), as well as other rare complications, such as intestinal hemorrhage, perforated tuberculous gastric ulcer, and splenic abscess (3.2%). In 42.1% of cases, surgery was ineffective and it was followed by the development of recurrent complications that required surgery. In HIV-infected patients, AT ran more severely. Overall mortality in patients with AT was 47.4%, that in patients with and without HIV infection was 58.3 and 43.7%, respectively.