CT Appearances in Treated Abdominal Tuberculosis: A Radiologist's Dilemma

Objective To study the CT appearances of the abdomen after completion of antitubercular therapy (ATT) in adult patients. Methods Multidetector CT scan abdomen was done in 20 adults within 1 month of completing ATT. CT appearances were compared with pretreatment scans which were available in 7 cases. Results We found that residual ileocecal wall thickening and enhancement was significant (p < 0.05) after treatment in cases of ileocecal tuberculosis (TB). Mild decrease in wall thickness and diameter of the involved dilated small bowel loops was seen. Numerous large, matted nodes with necrosis persisted in the mesentery and retroperitoneum in treated TB, but reduction in the size of nodes was appreciated. Conclusion Our results help to fill the vacuum in the database of CT appearances in treated abdominal TB. Persistence of bowel changes and lymph nodes should not be mistaken for recurrence of TB or residual disease.

Computed Tomographic Colonography Findings in Ileocecal Tuberculosis

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LAPAROSCOPIC ASSISTED RIGHT HEMICOLECTOMY

Objective: To assess the outcome of laparoscopic assisted right hemicolectomy in benign diseases like tuberculosis. Studydesign: Prospective observational study. Setting: Surgical unit –I of Jinnah Hospital Lahore. Period: Jan 2009 and June 2010. Material andMethods: This study included a series of twenty patients with preoperative clinical diagnosis of ileocecal tuberculosis. A three trocar techniquewas used to perform laparoscopic right hemi colectomy and anastomosis was performed outside the abdomen by extending the supraumbilicalincision. Results: Data of 20 patients who underwent laparoscopic assisted right hemicolectomy was analyzed. Mean age of the patients was27.5 years with male to female ratio 4:1 (Table-I). There was zero conversion(0%) to open surgery and no intra-operative complications(0%)were observed. Average hospital stay was 5.8 days. No patient had to be re operated. On histopathology of specimen final diagnosis was 95%ileo cecal tuberculosis and one patient (5%) turned out to be having lymphoma (Table-III). Conclusions: The laparoscopic colon surgery canproduce excellent results in selected patients of abdominal tuberculosis. Advantages of laparoscopic over open surgery include lesspostoperative pain, short-term postoperative ileus, earlier return to daily activity.