Rate of Incidental Finding of Intestinal Tuberculosis in Preoperatively Unsuspected Laparotomy: Experience of 300 Cases in Bangladesh

Background: Detection of intestinal tuberculosis is very crucial for the management of the patient.

Objective: The purpose of the present study was to find out the incidence of intestinal tuberculosis in clinically unsuspected laparotomies.

Methodology: This cross-sectional study was conducted in different units of the Department of Surgery at Dhaka Medical College Hospital, Dhaka from March 2002 to March 2004 for a period of two (2) years. Purposive sampling was done according to availability of the patients and strictly considering the inclusion and exclusion criteria. Patients with no suspicion about pulmonary as well as intestinal tuberculosis, history of cough & haemoptysis, no history of antitubercular drug taken, diagnosed as other than tuberculosis, per operative suspicion raised by any one or more of followings criteria like enlarge lymph nodes in mesentery, omental masses, ileocaecal masses, suspicious growth in ileum, omental thickening, perforation suspected by tuberculosis were selected as study population. Biopsy was taken from suspicious lesions. Histopathology was confirmed the granulomatous lesion. Patients with known case of tuberculosis, suspicion about pulmonary tuberculosis, history of cough & haemoptysis, previously treated with antitubercular drugs and chest X-ray with suspicion of pulmonary tuberculosis were excluded from this study.

Results: A total number of 300 patients under laparotomy were recruited for this study after fulfilling exclusion and inclusion criteria of which 38 positive cases were found in the study with a percentage of 12.7%. Maximum affected age group was 21 to 30 years which was 16(42%) cases. In all histologically positive cases granulomatous inflammation were found in 12(31.6%); both granuloma & caseation necrosis was reported in 719(50.0%) cases; furthermore, with this Langhan’s giant cell, caseation necrosis were also found in 7(18.4%) cases.

Conclusion: In conclusion the incidence of intestinal tuberculosis is very high among the preoperatively unsuspected laparotomy patients.