A patient recently visited Dr. Vanesha Varik at Aster Hospital, Mankhool with complaints of severe abdominal pain, continuous vomiting [in spite of no food intake] and obstipation in nearly 36 hrs. Upon examination, the patient was found to be well built, though uneasy and contorted in pain. His abdomen was distended and tender with a tympanic note on percussion and hyperperistaltic, tinkling bowel sounds. The patient’s blood work did not reveal any infection but an ultrasound report showed dilated bowel loops, multiple splenic abscesses and some free fluid. Further investigation through a CT Scan confirmed a 4 cm dilation of bowel loops and a distal ileum collapse, along with splenic granulomas /evolving abscesses . Dr. Vanesha, after discussing CT scan findings with Dr. Naveen, suspected a double stricture/band around 2 loops. All of the patient’s reports overtly implied an intestinal obstruction secondary to tuberculous etiology.
The patient was informed about the need for a surgery and a laparoscopy revealed a picture consistent with the diagnosis [Image 1] – an abdomen full of tubercles scattered on all the organs, bowel loop, peritoneal and omental surface; multiple lymph nodes over bowel serosal surface and mesentery. The dilated bowel loops showed a sudden collapse of 15-30 cm from IC junction due to a thick band [Image 2] which had enveloped 2 bowel loops causing constriction and external obstruction. This band was cut and excised laparoscopically, showing an immediate release of the obstruction and refilling of the collapsed segments. Biopsies of the peritoneum and omentum were also taken.
After the surgery, the patient recovered well, passed stools and was discharged after tolerating full diet. The histopathology report confirmed a tuberculous etiology and he was referred for an anti-tuberculous treatment.
Specialist General & Laparoscopic Surgeon
Aster Hospital, Mankhool