OUTCOMES OF SURGICAL TREATMENT OF COMPLICATED ABDOMINAL TUBERCULOSIS
We conducted a retrospective analysis of the case histories of 31 patients with abdominal tuberculosis (TB). The patients were treated in the surgical department of the Krasnoyarsk Regional TB Dispensary during the period from 2013 to 2018. In all patients, intraoperatively detected and histologically confirmed tuberculosis of the abdominal organs was combined with widespread pulmonary tuberculosis, while in 26 patients it was combined with HIV infection. All operations were performed for urgent indications of «acute abdomen», including 25 cases of intestinal perforation, 4 cases of adhesive intestinal obstruction, and 2 cases of interintestinal abscesses. As it was revealed, a latent clinical picture is characteristic for complications of abdominal tuberculosis, this being the reason for the late diagnosis of «acute abdomen». During the operation, adhesive (viscid) tuberculous peritonitis was revealed in 6 patients (19.4%); in 4 patients (12.9%) TB was complicated by adhesive intestinal obstruction and in 2 patients (6.5%) by interintestinal abscesses. The remaining 25 patients (80.6%) had a picture of diffuse purulent peritonitis caused by perforation of a tuberculous intestinal ulcer. The postoperative period was characterized by a large number of severe postoperative complications (90%), and as a result, a high postoperative lethality (77.4%). Specifically, 31 of 24 people died: one person died during the operation, and 23 patients died within the postoperative period. In 23 (95.8%) of 24 deaths, patients had tuberculosis combined with HIV infection. Among the HIV-infected, the mortality rate was 88.5%. In patients with HIV infection, with a CD4 lymphocyte level below 100 cells, death occurred in 100% of cases (23 persons). Thus, the analyzed treatment results were recognized as unsatisfactory, this requiring further study of the problem in order to increase the efficiency of treatment.