Outcomes of Abdominal Tuberculosis Referred for Surgical Management in a Tertiary Care Center in Nepal

Background: While abdominal tuberculosis (ATB) is a great masquerader, it can cause significant morbidity and mortality. We aim to evaluate the presentation and management outcomes of patients with abdominal TB referred to us for surgical management. Methods: This is a retrospective study of patients with definitive or presumed ATB from January 2010 to July 2022 at a tertiary care hospital in Nepal. The data on clinical presentation, diagnosis, management, and short-term outcomes were analyzed. Results: Sixty-six patients with a definitive (25) and presumed (41) diagnosis of ATB were analyzed with a mean age of 32.6 years. Patients presented with moderate to severe anemia (57.1%), intestinal obstruction (53.0%), abdominal lump (30.3%), intestinal bleeding (4.5%), and peritonitis (27.3%) including intestinal perforation (6.1%). A total of 34 (51.5%) patients received surgical management. Intestinal obstruction was a significant risk factor for the need of surgery. Conservative management was successful in 37.1% and 31.3% of patients with intestinal obstruction and peritonitis respectively. Ileum and caecum were the most common sites of intestinal tuberculosis. Bowel resection and stoma were done in 13 (38.2%) and 10 (29.4%) patients respectively. There were 4 (6.1%) overall mortality including two operative mortalities. The common surgical complications were iatrogenic bowel injuries (13.1%), wound infection (32.3%), rectus sheath dehiscence (17.6%), and intra-abdominal abscess (14.7%). The median hospital stay was 8.5 days. Conclusion: Surgical intervention in complicated ATB is associated with high morbidity and mortality. Judicious conservative management in ATB can be tried in selected patients.