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1. AN INTRIGUING CASE SERIES ON INTESTINAL
OBSTRUCTION IN TB ABDOMEN - WHEN AND WHEN NOT
TO OPEN
Presenting author:Dr. C.V.Aruneshwar, Post graduate
Guide: Prof. Dr. S.P. Gayathre MS, DGO
Govt. Stanley Medical college and Hospital
Introduction :
• The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB)
•Imaging modalities guide the line of evaluation
•Polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) have low sensitivity.
• Ascitic adenosine deaminase and histological clues provide specificity to diagnosis.
•A diagnostic trial of antitubercular therapy (ATT) may be considered especially in TB-endemic regions.
Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for
early response assessment and should be sought at two months.
For most forms of abdominal tuberculosis, six months of ATT is sufficient.

2. O/E
Vitals stable, GC Fair
Abdomen distended with diffuse
tenderness.
BS Hyperdynamic.
DRE: Faecal staining +
Blood Panel – Normal
CXR - Normal
CECT Abdomen Pelvis :
Dilated small bowel loos with air
fluid level with maximum diameter
of 3.8 cm with the proximal ileum as
the cutoff point and collapsed distal
ileum.
Case capsule: #1
55/F - Diffuse abdominal pain
H/o not having passed stools or flatus
K/c/o Hypothyroid, Underwent 2 LSCS
Fig 1. Cocoon Abdomen
HPE :
Chronic Inflammatory Pathology
Procedure :
Emergency laparatomy carried out.
Cocoon abdomen was noted with dense
adhesions extending from a point 100cm
from the Duodenojejunal flexure till a
point 100 cm from the ileocaecal
junction, for a total length of 200 cm.
Adhesiolysis carried out.
Fig 2. Post adhesiolysis
Case capsule: #2
48/F , k/c/o EPTB on Rx -
Diffuse abdominal pain,
constipation ,vomiting x 6 months,
aggaravated since initiating ATT.
O/E
Dehydrated, drowsy, pale, poor
built
Abdomen distended with
diffuse tenderness and visible
peristalisis.
BS Hyperdynamic.
DRE: Faecal staining +
Blood Panel – Anaemia,
thrombocytpenia,Hypokalemia
CECT Abdomen Pelvis :
Dilated small bowel loops with a
maximum diameter of 3.6 cm
with mid ileum as the transition
point.
Management :
Diagnosed as a case of Subacute small
bowel obstruction with superimposed
hypokalemia leading to paralytic ileus.
Conservative management initiated
with correction of hypokalemia as
aim.
After Initiating IV K correction, K
levels were transiently corrected –
Normal bowel sounds ensued and
patient passed stools.
Patient developed refractory
hypokalemia afterwards and as a result
of which developed cardiac arrest.

3. Discussion:
Discussion:
•Abdominal TB is an infection of the gastrointestinal tract, peritoneum, solid abdominal viscera, or abdominal
lymphatics with M. tuberculosis [1]. Risk factors include cirrhosis, HIV, diabetes, malignancy, chemotherapy, and
peritoneal dialysis.
•Abdominal TB is noted for its varied clinical presentation. It can mimic many clinical gastrointestinal conditions,
presenting as acute, chronic, acute-on-chronic, or even incidentally.Abdominal TB poses a considerable diagnostic
challenge due to nonspecific symptoms, diagnostics, and findings.
•Laboratory investigations are nonspecific and unhelpful in the diagnosis of abdominal TB.
•A high index of suspicion is required, and diagnosis chiefly relies on strong clinical suspicion and aggressive
investigation.
•The mainstay of treatment is medical therapy though timely surgical intervention is required in a sizable number of
patients.
•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.
References
1. World Health Organization. Global Tuberculosis Report 2018. Geneva: World Health Organization; 2018.
2. Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract:
Revisited. World J Gastroenterol. 2014;20:14831–40.]
3. Singh H, Krishnamurthy G, Rajendran J, Sharma V, Mandavdhare H, Kumar H, et al. Surgery for abdominal
tuberculosis in the present Era: Experience from a tertiary-care center. Surg Infect (Larchmt) 2018;19:640–5.