DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150777

Incisional hernia as a late surgical complication of an infertile patient treated for abdominal tuberculosis

Kameshwarachari Pushpalatha, Tushar Subhadarshan Mishra, Nerbadyswari Deep

Abstract


Abdominal tuberculosis (TB) can be of various forms including peritoneal TB, tuberculous lymphadenopathy, gastrointestinal TB and visceral TB. The potential pathway includes direct spread to the peritoneum from infected adjacent foci, including the fallopian tubes or adnexa, or psoas abscess, secondary to tuberculous spondylitis. The exact stimulus for the inflammatory reaction is not known, but some suggest that it may arise due to a subclinical primary viral peritonitis, as an immunological reaction to gynaecological infections, or due to retrograde menstruation. The diagnosis of extra pulmonary TB can be difficult as it presents with nonspecific clinical and radiological features and requires high degree of suspicion for diagnosis. The abdominal TB, which is not so commonly seen as pulmonary TB, can be a source of significant morbidity and mortality and is usually diagnosed late due to its nonspecific clinical presentation. Approximately 15%-25% of cases with abdominal TB have concomitant pulmonary TB. Hence, it is quite important in identifying these lesions with high index of suspicion especially in endemic areas. Post – operative period in such patients is not smooth. They include prolonged hospital stay, enterocutaneous fistulae requiring re-operation upon failed conservative management, mortality associated with re-exploration, late complication being incisional hernia. Here we report a case of large incisional hernia following a laparotomy performed for non-resolving sub-acute intestinal obstruction which turned out to have tubercular origin later. The present case was managed by meshplasty using component separation technique (CST).

Keywords


Abdominal tuberculosis, Incisional hernia, Component separation technique

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References


Lazarus AA, Thilagar B. Abdominal tuberculosis. Dis Mon. 2007;53:32-8.

Rasheed S, Zinicola R, Watson D, Bajwa A, McDonald PJ. Intra-abdominal and gastrointestinal tuberculosis. Colorectal Dis. 2007;9:773-83.

Mamo JP, Brij SO, Enoch DA. Abdominal tuberculosis: a retrospective review of cases presenting to a UK district hospital. QJM. 2013;106(4):347-54.

Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg. 1985;72:70-1.

Sugerman HJ, Kellum JM, Reines HD, et al. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171:80-4.

Anthony T, Bergen PC, Kim LT, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24:95-100.

Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237:129-35.

Bensley RP, Schermerhorn ML, Hurks R, Sachs T, Boyd CA, O'Malley AJ, Cotterill P, Landon BE.J Am Coll Surg. Risk of late-onset adhesions and incisional hernia repairs after surgery. 2013;216(6):1159-67

Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol. 2004;10:3647-9.

Chang SH, Kim CS, Lee KS, Kim H, Yim SV, Lim YJ, Park SK .Premenopausal factors influencing premature ovarian failure and early menopause. Maturitas. 2007;58(1):19-30.

Kalantaridou SN, Nelson LM. Premature ovarian failure is not premature menopause. Ann N Y Acad Sci. 2000;900:393-402.

George CD, Ellis H. The results of incisional hernia repair: a twelve-year review. Ann R Coll Surg Engl. 1986;68:185-7.

Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392-8.

Adekunle S1, Pantelides NM, Hall NR, Praseedom R, Malata CM. Indications and outcomes of the components separation technique in the repair of complex abdominal wall hernias: experience from the cambridge plastic surgery department. Eplasty. 2013;13:e47.