ABDOMINAL TUBERCULOSIS: RETURN TO SURGERY
1Moscow City Research and Practical Center for Tuberculosis Control, Moscow City Health Department, Moscow, Russian Federation
2Pirogov Russian National Research Medical University, Moscow, Russian Federation
Objective: Еo determine the optimal tactics of diagnosis and surgical treatment of abdominal tuberculosis (AT).
Methods: In the period from 2012 to 2018 years, 229 patients with AT were examined and operated in the Tuberculosis Surgery Department of the Clinic № 2 of the Moscow City Scientific and Practical Center for the Control of Tuberculosis. In the patient survey complex included polypositional X-ray and CT scan of the abdominal cavity and chest, ultrasound of the abdominal cavity, diagnostic video-laparoscopy, laboratory and morphological methods of examinations. A total of 345 operations were performed, including relaparotomy. The surgical interventions for all patients were carried out in terms from 6 to 68 hours from the moment of disease.
Results: It was revealed that pulmonary tuberculosis was found in the vast majority of patients (n=207; 90.4%). HIV infection was also diagnosed in most patients (n=172; 75.1%). The most frequent indications for surgical treatment were peritonitis on the basis of perforations of tuberculous ulcers of various intestinal sections (n=89; 38.9%), peritoneal tuberculosis (n=52; 22.7%), acute intestinal obstruction of tubercular nature (n=56; 24.5%). These complications were the reasons for the holding of emergency or urgent operational benefits, often quite extended volume. Often, the diagnosis of AT in most patients was established on the basis of intraoperative findings. Assume the tuberculous nature of an urgent surgical disease were only available in patients with previously diagnosed pulmonary tuberculosis
Conclusions: Not timely detection of surgical complications of tuberculosis of the abdominal organs due to the erosion of symptomatic, the lack of alertness among surgeons regarding AT, defines the low efficiency of surgical treatment and the inadequacy of surgical tactics. Lethality in patients in the postoperative period remains quite high (19.2%), mainly counting patients with developed secondary peritonitis on the background of perforation of the tubercular ulcers of the intestine (28.1%). AT should be considered as a surgical problem, especially in cases of complications development. To solve the problems of early diagnosis of the patients with suspected tuberculosis of the abdominal cavity organs should be observed jointly by the surgeon and a phthisiatrician.
Keywords: Abdominal tuberculosis, peritoneal tuberculosis, ulcer perforation, HIV infection.
- Bogorodskaya EM, Sinitsyn MV, Belilovskiy EM, Borisov SE, Kotova EA. Vliyanie VICH-infektsii na strukturu vpervye vyyavlennykh bol’nykh tuberkulyozom, zaregistrirovannykh v g. Moskve [Impact of HIV infection on the structure of new tuberculosis cases detected in the city of Moscow]. Tuberkulyoz i bolezni lyogkikh. 2017;95(10):17-26. Available from: http://dx.doi.org/10.21292/2075- 1230-2017-95-10-17-26.
- Vasilyeva IA, Belilovskiy EM, Borisov SE, Sterlikov SA, Sinitsyn MV. Tuberkulyoz, sochetannyy s VICH-infektsiey, v stranakh mira i v Rossiyskoy Federatsii [Tuberculosis combined with HIV infection in the countries of the world and the Russian Federation]. Tuberkulyoz i bolezni lyogkikh. 2017;95(9):8-18. Available from: http://dx.doi.org/10.21292/2075-1230-2017-95-9-8-18.
- Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection associated tuberculosis: the epidemiology and the response. Clinical Infectious Diseases. 2010;50(Suppl.3):S201-S207. Available from: http://dx.doi. org/10.1086/651492.
- Bogorodskaya EM, Sinitsyn MV, Belilovskiy EM, Borisov SE, Kotova EA, Rybka LN. Vliyanie VICH-infektsii na strukturu pokazatelya zabolevaemosti tuberkulyozom v usloviyakh megapolisa [The impact of HIV infection on the structure of the indicator of tuberculosis incidence in the megalopolis]. Tuberkulyoz i sotsial’no znachimye bolezni. 2016;3:3-17.
- Ford N, Shubber Z, Meintjes G. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV. 2015;2:438-444. Available from: http://dx.doi.org/10.1016/S2352- 3018(15)00137-X.
- Nechaeva OB. Epidemicheskaya situatsiya po tuberkulyozu sredi lits s VICHinfektsiey v Rossiyskoy Federatsii [Tuberculosis epidemic situation among HIV positive people in the Russian Federation]. Tuberkulyoz i bolezni lyogkikh. 2017;95(3):13-9. Available from: http://dx.doi.org/10.21292/2075-1230- 2017-95-3-13-19.
- Sinitsyn MV, Belilovsky EM, Sokolinа IА, Reshetnikov MN, Tityukhinа MV, Bаturin OV. Vnelyogochnye lokalizatsii tuberkulyoza u bol’nykh VICH-infektsiey [Extrapulmonary tuberculosis in HIV patients]. Tuberkulyoz i bolezni lyogkikh. 2017;95(11):19-25. Available from: http://dx.doi.org/10.21292/2075-1230- 2017-95-11-19-25.
- Donoghue HD, Holton J. Intestinal tuberculosis. Current Opinion in Infectious Diseases. 2009;22:490. Available from: http://dx.doi.org/10.1097/ QCO.0b013e3283306712.
- Zyryanova TV, Poddubnaya LV, Fyodorova MV, Lipskiy KA. Tuberkulyoz organov bryushnoy polosti u bol’nykh tuberkulyozom lyogkikh [Abdominal cavity organs tubeculosis in lung tuberculosis patients]. Meditsina i obrazovanie v Sibiri. 2009;2:10-4
- Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World J Gastroenterol. 2014;20(40):14831- 40. Available from: http://dx.doi.org//10.3748/wjg.v20.i40.14831.
- Rathi P, Gambhire P. Abdominal tuberculosis. J Assoc Physicians India. 2016;64:38-47.
- Farantos Ch, Damilakis I, Germanos S, Lagoudellis A, Skaltsas S. Acute intestinal obstruction as the first manifestation of tuberculous peritonitis. Hellenic Journal of Surgery. 2013;85(3):192-6.
- Beppu K, Osada T, Matsumoto K, Shibuya T, Sakamoto N, Kawabe M. Gastrointestinal tuberculosis as a cause of massive bleeding. Medical Science Monitor. 2009;15(10):151-4.
- Pattanayak S, BehuriaIs S. Аbdominal tuberculosis a surgical problem? Ann R Coll Surg Engl. 2015;97(6):414-9. Available from: http://dx.doi.org/10.1308/ rcsann.2015.0010.
- Weledji EP, Pokam BT. Abdominal tuberculosis: Is there a role for surgery? World J Gastrointest Surg. 2017;9(8):174-81. Available from: http://dx.doi. org/10.4240/wjgs.v9.i8.174.
- Plotkin DV, Sinitsyn MV, Reshetnikov MN, Kharitonov SV, Skopin MS, Sokolina IA. Tuberkulyoznyy peritonit. «Zabytaya» bolezn’ [Tuberculous peritonitis. «Forgotten» disease]. Khirurgiya. 2018;12:38-44. Available from: http://dx.doi. org/10.17116/hirurgia20181213.
- Smotrin SM, Gavrilik BL. Khirurgicheskie oslozhneniya abdominal’nogo tuberkulyoza [Surgical complications of abdominal tuberculosis]. Zhurnal Grodnenskogo gosudarstvennogo meditsinskogo universiteta. 2011;3:69-70.
- Savonenkova LN, Anisimova SV, Sidorova YuD., Sidorov IA, Chunina AF. Letal’nost’ bol’nykh tuberkulyozom v usloviyakh epidemii VICH-infektsii [Mortality of tuberculosis patients during HIV-infection epidemic]. Ul’yanovskiy mediko-biologicheskiy zhurnal. 2018;3:99-106. Available from: http://dx.doi. org/10.23648/UMBJ.2018.31.17220.
- Reshetnikov MN, Skopin MS, Sinitsyn MV, Plotkin DV, Zubаn ON. Vybor khirurgicheskoy taktiki pri perforativnykh tuberkulyoznykh yazvakh kishechnika u bol’nykh VICH-infektsiey [The choice of surgical tactics in perforated tuberculous intestinal ulcers in HIV patients]. Tuberkulyoz i bolezni lyogkikh. 2017;95(9):19-24. Available from: http://dx.doi.org/10.21292/2075-1230- 2017-95-9-19-24.
- Kawazoe A, Nagata N. Intestinal tuberculosis in an HIV-infected patient with advanced immunosuppression. Clin Gastroenterol Hepatol. 2012;10(9):A24- 26. Available from: http://dx.doi.org/10.1016/j.cgh.2012.03.013.
Plotkin Dmitriy Vladimirovich , Candidate of Medical Sciences, Employee of the Tuberculosis Surgery Department of the Clinic № 2, Moscow City Research and Practical Center for Tuberculosis Control; Associate Professor, Department of General Surgery and Radiology, Medical Faculty, Pirogov Russian National Research Medical University ORCID ID 0000-0002-6659-7888
Reshetnikov Mikhail Nikolaevich , Candidate of Medical Sciences, Surgeon at the Tuberculosis Surgery Department of Clinic № 2, Moscow City Research and Practical Center for Tuberculosis Control ORCID ID: 0000-0002-4418-4601
Gafarov Umedzhon Olimdzhonovich, Candidate of Medical Sciences , Surgeon at the Tuberculosis Surgical Department of Clinic № 2, Moscow City Research and Practical Center for Tuberculosis Control
Belentseva Olga Viktorovna , Surgeon at the Tuberculosis Surgery Department of Clinic № 2, Moscow City Research and Practical Center for Tuberculosis Control
Stepanov Evgeniy Alekseevich , Candidate of Medical Sciences, Assistant of the Department of General Surgery and Radiology, Medical Faculty, Pirogov Russian National Research Medical University
Sinitsyn Mikhail Valerievich , Candidate of Medical Sciences, Acting Director, Moscow City Research and Practical Center for Tuberculosis Control ORCID ID: 0000-0001-8951-5219
Address for correspondence:
Gafarov Umedjon Olimdzhonovich
Candidate of Medical Sciences, Surgeon at the Tuberculosis Surgical Department of Clinic № 2, Moscow City Research and Practical Center for Tuberculosis Contro
107014, Russian Federation, Moscow, str. Stromynka, 10
Tel.: +7 (926) 1875050
Materials on the topic:
- STIGMA AND DISCRIMINATION ASSOCIATED WITH TUBERCULOSIS
- IMPROVEMENT RESULTS OF DIAGNOSIS AND TREATMENT OF ABDOMINAL TUBERCULOSIS
- DYNAMICS OF THE INDICATORS OF LUNG DESTRUCTION AND HORMONAL BACKGROUND AS A PREDICTIVE MARKER OF THE EFFECTIVENESS OF MULTIDRUG RESISTANT TUBERCULOSIS TREATMENT
- ULTRASOUND DIAGNOSTICS OF ABDOMINAL TUBERCULOSIS IN THE CONDITIONS OF THE OUTPATIENT-DIAGNOSTIC DEPARTMENT
- EFFICACY OF TUBERCULOSIS CASES DETECTION AMONG THE POPULATION OF DUSHANBE IN THE REPUBLIC OF TAJIKISTAN
- THE FREQUENCY OF DEVELOPMENT OF TUBERCULOSIS AMONG CITIZENS OF THE REPUBLIC OF TAJIKISTAN, LEAVING TO LABOR MIGRATION
- THE ROLE OF THE IMPLANTABLE PORT SYSTEM FOR THE CENTRAL VENOUS ACCESS IN TREATMENT OF PULMONARY TUBERCULOSIS WITH MULTIPLE AND EXTENSIVELY DRUG RESISTANCE (PRELIMINARY RESULTS)
- SURGICAL TREATMENT OF PULMONARY AND EXTRAPULMONARY TUBERCULOSIS
- THE INFLUENCE OF BCG VACCINATION ON THE STRUCTURE OF CLINICAL FORMS OF TUBERCULOSIS IN CHILDREN FROM THE FOCI OF INFECTION AND FROM UNSPECIFIED CONTACT FOR TUBERCULOSIS
- TUBERCULOSIS OF WORKERS OF MEDICAL ORGANIZATIONS IN THE KYRGYZ REPUBLIC, 2015-2017