Pediatr Sur g Int (1990) 5:3 92 -396 Pediatric ur ery International © Springer-Verl ag 1990 Abdominal tuberculosis in children - surgical management A 10-year review of 95 cases A. J. W. Millar, H. Rode, and S. Cywes Department of Paediatric Surgery, University of Cape Town, Institute of Child H ealth and Red Cross War Memorial Children's H ospital, 7700 Ronde- bosch, Cape To wn, Republic of South Africa. Abstract. During the period 1980-1989, 95 patients, mean age 5 years, with abdominal tuberculosis (ATB) cent were malnourished. Apart from fever, loss of weight, and failure to thrive, symptoms of abdominal pain, vomit- ing, and diarrhoea predominated. Abdominal distension (86%) and a palpable mass (57%) were the most comm on physical findings. Sixty-three per cent had radiological evidence of chest disease. Abdominal ultrasound was use- ful in identifying ascites and distribution of lymph node masses. Fifty of the 95 patients were managed on the surgi- cal unit and the predominant involvement was: peritoneal 21, nodal 15, enteric 11, and undetermined 3. Thirteen of this group developed one or more complications - perfora- tion (4), obstruction (7), abscess or fistulae (5), and haemorrhage (1). Surgery involved diagnostic laparotomy, extra-abdominal biopsy, and management of the complica- tions. Emergency surgery was conservative. Definitive sur- gery for stricture-plasty, resection, and stoma closure was delayed at least 8 weeks to allow for chemotherapeutic effect. Uncomplicated TB responded rapidly to therapy. There were no deaths in this group. Thirty-seven of the 45 "medical" cases made an uncomplicated recovery on anti- TB therapy. Three died due to generalised disease, 5 had complications (chylous ascites 2, protein-losing enter- opathy 3) and 3 had relapse of disease due to poor compli- ance. The morbidity and mortality of this ubiquitous dis- ease can be greatly reduced by timely diagnosis, which often requires early recourse to diagnostic laparotomy, and appropriate surgery and supportive care for complicated disease. Key words: Abdominal tuberculosis - Complications - Surgical management Offprint requests to: A. J. W. Millar Introduction Abdominal tuberculosis (ATB) is still an important disease in developing countries and immigrant populations [1, 4, 7]. Its importance lies not so much in its incidence, but because the diagnosis is often initially overlooked due to nonspecificity and variability in clinical presentation [10]. With delay in instituting antituberculous therapy mor- bidity can be severe, however early and appropriate treat- ment yields an excellent response. ATB has been less often studied in the paediatric population. This paper supple- ments previous reports on two series of patients with ATB seen at the Red Cross Children's Hospital since 1961, and concentrates on the role of the surgeon in the diagnosis and treatment [2, 5]. Materials and methods Records of all patients admitted to this hospital with a diagnosis of ATB over the 10-year period 198 0-1 989 were reviewed. Patients were either admitted directly to the surgical wards, refer red to the surgeons from the medical wards because of doubt in diagnosis or development o f compli- cations, or were managed entirely by the paediatricians. The patients included in the study had the diagnosis established by: (1) histological evidence from biopsy specimens obtained at laparotomy; or (2) proven systemic or pulmonary TB with clinical and radiological features consis- tent with ATB, with subsequent good clinical response to anti-TB drug therapy. This latter group were almost exclusively managed by our paediatricians. Patients received oral quadruple therapy o f rifampicin, isoniazid, pyrazi namide, and ethambutol till discharge either home or to a TB hospital. Subsequent triple therapy was usually continued for a minimum of 6 months. Patients requiring surgical intervention were analysed with regard to indications for surgery, area o f residence (urban or rural), clinical presen- tation, laboratory and radiological investigations, findings at operation, complications, and surgical management strategies. The clinical features of those treated by the surgical unit were compared to those treated on the medical side. The long-term outcome of all patients was not obtained, but in most cases follow-up hospital notes were available. Assessment of number of days patients required parenteral nutrition and the total num- ber of days in hospital.
