Surgery - TB

Q: My brother was detected with TB in the neck. He had undergone surgery and was on medication for 18 months. All of a sudden one day he had uncontrollable vomitting and pain in the abdomen. After scanning it was found that adhesions had formed all over the small intestine. He underwent surgery and on opening it was found that the intestine was all plastered. The doctor stated that he had cleaned the visible part and then closed. My brother was then under homeopathic as well as allopathic treatment. After surgery the intake of food was minimal and off and on he used to have a bout of vomitting and diarrhoea. He was once kept in a Mumbai hospital for observation. He was discharged after a week. He was progressively losing weight. Although surgery was suggested because of loss in weight the surgery was ruled out because of deficiency of protein and haemoglobin. He has started swelling all over the body from leg to abdomen. Please advise.

A:It appears that your brother is suffering from abdominal tuberculosis. Abdominal tuberculosis is one of the commoner variants of tubercular infection in the body. Although not as common as lung TB, it is nevertheless a serious health problem in India. The abdomen consists of intestines and associated tissues, in particular a tissue called the peritoneum. If the peritoneum develops TB the entire abdominal contents can get plastered, much as sheets of paper become stuck with glue. Surgery is very difficult, and often accompanied with copious loss of blood. Your brother is obviously very symptomatic, so it is not correct to do nothing. I presume that he has received a full course of antitubercular treatment. Please do confirm this. Your clinical details are incomplete, but it appears that he needs a detailed evaluation to consider the possibility of a careful operation. Since he is very weak he will need to be built up, by which we mean that he requires blood and nutrition before any procedure can be thought of. In the meantime please send the following information:

  • How old is your brother?
  • The medicines he has already taken (in detail)
  • The frequency of vomiting
  • The nature of stools: is there constipation alternating with diarrhea?
  • Does he develop abdominal bloating?
  • Does he have abdominal pain? If so, how severe is it?
  • What is the rate of weight loss?
  • Does he have any other illnesses (diabetes, hypertension, allergies...) Please understand that surgery will be difficult and dangerous, but if he is as symptomatic as I suspect, and if he is losing weight rapidly, he needs intervention.

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