Frequency of tuberculous intestinal perforation: What to do for perforation-Guidelines

Objective: To determine the frequency of intestinal tuberculosis in patients of intestinal perforation presenting in surgical emergency and find feasible procedure like primary closure, resection anastomosis or ileostomy for perforation of gut along ATT. Methodology: This descriptive, quasi experimental cross-sectional study was conducted at Department of Surgery, Bahawal Victoria Hospital, Bahawalpur, Pakistan from Feb 1, 2017 to February 30, 2018. It included 106 patients with intestinal perforation with age 12-70 years. Patients with history of typhoid, duodenal perforation and traumatic perforation were excluded. Patients were further scrutinized on clinical diagnosis and laparotomy was performed and diagnosis confirmed on histopathology. Procedures like primary closure, resection anastomosis or ileostomy done on set criteria. Anti-tuberculous drugs were started to all patients after histopathology report. Complications and mortality were noted. Results: Out of 106 patients, 58 (54.72%) were between 36 to 50 years of age. Mean age was 36.90±8.16 years. 69 (65.09%) were male and 37 (34.91%) were females with male to female ratio of 1.9:1. A total of 19 (17.92%) patients had perforation. out of these 19, primary closure was done in 4 (21.05%), resection anastomosis in 7 (36.84) and ileostomy in 8 (42.1%). Procedural failure was noted in 2 (28.57%) patients of resection anastomosis out of 7. Complications were noted in 7 (36.84%) and mortality in 2 (10.52%) out of 19 patients. Conclusion: Frequency of intestinal tuberculosis in patients of intestinal perforation is quite high (17.92%) in our region. We recommend primary closure of small perforation less than 1 cm on pliable, non-edematous gut, with no contamination with stable patient, ileostomy in inflamed gut having large or multiple perforation, stricture jumbled mass, unstable patients and resection anastomosis only for gut in which after resection of area of perforation or stricture gut is pliable non-edematous with no contamination in a stable patient