Abdominal Koch's

A 36 year old Male presents with abdominal pain and distension with vomiting and constipation since two days. On evaluation, a diagnosis of Intestinal obstruction was made and this was the intraoperative finding. Confirmed to be an abdominal Koch's. Notice the discolored bowel loops, closed loop obstruction and multiple air-fluid levels on the x-ray. In a country like ours, never underestimate the prevalence of TB, irrespective of the organ system. @therealfarmanali #docfortmeducation #medicalmentors #medicalstudents #medicaleducation #intestinehealth

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It is definitely a case of intestinal tuberculosis with intestinal obstruction as there is colour change of the intestines. Obstruction is due hyperplastic intra mural thickening and adhesion needs surgical intervention. . Primarily treatment of tuberculosis is medical if we can make an early diagnosis which is a very challenging one.

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Pain,distension, vomiting and constipation are the cordial presentation of intestinal obstruction. The X-ray is also typical with dilated bowel loops and multiple fluid levels. In our country Koch's abdomen is a prevalent cause of intestinal instructions.

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Dilated loops. ? Thickened walls. ?? Lymphnodes. ? Tubercular

Yes. Its a case of Koch's Peritonitis.

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In india - Abdominal or intestinal tuberculosis is most difficult to diagnose and also prevalence in india is also very high . I think - all cases of pain abdomen which are resistant to treatment- main D/D should be IBS , IBD and abdominal tuberculosis. Many a times all investigations including ESR , Mountoux test, X - ray abdomen, CECT are inconclusive- though PCR is sometimes helpful in diagnosis .Even colonoscopy may be normal . This case is nicely diagnosed and best possible treatment has been done . As this disease is not common in the west- the latest edition of BAILEY AND LOVE 'S SHORT PRACTICE OF SURGERY has written very little on abdominal tuberculosis. When I was studying in I983 - chapter on abdominal tuberculosis was exhaustive in the same text book and so new generation doctors are not well versed with abdominal tuberculosis as it is not taught well in their curriculum- although the incidence of Abdominal tuberculosis- including ileocaecal , mesentric and genito- urinary has not declined in india . Any how - well done Dr Farman Ali

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Symptoms pain / distention. /nausea /contipation Intestinal obstruction air fuid levels in the x-ray Thickening of intestine ...All features favours TB Biopsy will confirm the diagnosis

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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It looks that it is case of intestinal obstruction due to hypokinetic small and large bowel. Could be IBS-C too if it was chronic constipation.

Correct diagnosis Correct approach Well done!

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