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Can adhesions be prevented after tuberculosis?

Q: I am a 31 years old male suffering from intestinal tuberculosis for the last 11 months and was on anti-tuberculosis treatment (ATT). While being on ATT I had jejunal stricture and perforation eight months back and again had ileal stricture and perforation just a month back. I underwent laprotomy and resection anastomosis on both of these occasions. Histopathology of previous resected sample confirmed tuberculosis. The doctor told me that gut during first surgery was very unhealthy but has marked improvement during second surgery. During second surgery, a few adhesions were present, which have been removed during the surgery. Now the doctor told me that gut was explored completely but no other lesion has been found. There is a marked improvement in terms of weight gain and appetite since ATT has been started. Now, I am worried about further complications of laprotomy like adhesions. Is there any way to prevent adhesions? Can adhesions be removed laparoscopically?

A:I note that you were diagnosed to have Intestinal Tuberculosis and were put on appropriate drug therapy. As you may know tuberculous infection always produces ulcers in the infected area. The ulcer causes pus and while on treatment, when healing takes place, scars get formed in the area. In the abdomen during this process the sticky pus resolves with treatment and in the abdominal cavity the adjacent tissue / gut gets involved during the scar formation by adhesions. It is very likely that the infection in your bowels at two sites, jejunum and the terminal ileum, caused strictures during healing that needed surgical intervention. Tuberculous infection is always treated with a prolonged period of drug therapy as the healing tends to be a slow process. Now that you are well the chances of further strictures are nil. After having said this, there is an inflammatory bowel condition called Crohn's disease which tends to be chronic but is not an infection. This condition is very difficult to diagnose but does not respond to anti - tuberculous therapy. But this needs to be kept in mind if you have any further unfortunate recurrence, as treatment for Crohn’s disease is different. So it is mandatory that you get followed up and assessed regularly by a gastroenterologist.

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