Clinical Spectrum of Extrapulmonary Tuberculosis from Pediatric Surgical Perspective

Objective: To identify modes of clinical presentation in extrapulmonary tuberculosis of childhood. Material and Method: All children diagnosed with extrapulmonary tuberculosis in a pediatric surgery clinic during the years 2000-2017 were reviewed retrospectively. Their files were evaluated for clinical presentation, laboratory and radiologic findings, pathology results, surgical details and postoperative complications. Results: Six girls and seven boys with the median age of 36 months were evaluated. The most common affected area was axillary lymph nodes in 8 patients and excisional biopsy was performed in all of them. The other foci of tuberculosis were intraabdominal. Abscess emerging from psoas muscle were drained in 2 patients. Ileocecal resection in one and adhesiolysis and biopsy from intestinal wall were performed in the other patient with intestinal involvement. Incisional biopsy was taken in adolescent with ovarian tuberculosis. A congenital immunodeficiency syndrome accompanied in 5 patients and further investigation proved miliary tuberculosis in 2 of them. History of contact with tuberculosis was positive in 4 children. Pathologic examination of surgical specimen showed caseification necrosis in 6 and granulomatous inflammation in all of the cases. Microbiologic evidence for tuberculosis infection was positive in 5 cases. Postoperative complication were adhesive intestinal obstruction in one and skin fistulization in 4 patients. Except the child with miliary tuberculosis and immunodeficiency, all other patients survived the disease with antituberculosis treatment. Conclusion: Extrapulmonary tuberculosis may be present with various clinical pictures. Surgery has an important role in tissue diagnosis and in complications caused by the disease.

Çocuk Cerrahisi Bakış Açısıyla Ekstrapulmoner Tüberkülozun Klinik Spektrumu

Amaç: Çocukluk çağında görülen ekstrapulmoner tüberkülozun klinik başvuru tiplerini tanımlamak. Gereç ve Yöntem: 2000-2017 yılları arasında bir çocuk cerrahisi kliniğinde ekstrapulmoner tüberküloz tanısı konan tüm olgular geriye dönük olarak değerlendirildi. Dosyalar, başvuru yakınmaları, laboratuvar, görüntüleme, patoloji sonuçları, ameliyat bulguları ve sonrası komplikasyonlar açısından incelendi. Bulgular: Ortalama yaşı 36 ay olan 6 kız, 7 erkek toplam 13 olgu değerlendirmeye alındı. En sık tutulan bölge 8 olgu ile aksiller lenf nodlarıydı ve tümüne eksizyonel biyopsi yapıldı. Diğer olgularda görülen tüberküloz odakları karın içindeydi. Psoas kası absesi olan iki olguda abse drenajı yapıldı. İntestinal tutulumu olan olgulardan birinde ileoçekal rezeksiyon, diğerinde ise adezyolizis ve bağırsak duvarından biyopsi alınması işlemleri yapıldı. Over tüberkülozu olan olgudan ise insizyonel biyopsi alındı. Olguların 5’inde eşlik eden konjenital immün yetmezlik vardı ve bunların 2’sinde miliyer tüberküloz tespit edildi. Alınan öyküden, 4 çocukta tüberküloz ile temas olduğu öğrenildi. Patolojik incelemede 6 olguda kazeifikasyon nekrozu ve tüm olgularda granülomatöz inflamasyon tespit edildi. Beş olguda tüberküloz açısından mikrobiyolojik kanıt saptandı. Ameliyat sonrası komplikasyonlar bir olguda adeziv bağırsak tıkanıklığı ve 4 olguda cilde fistül gelişmesiydi. İmmün yetmezlik ve miliyer tüberkülozu olan olgu haricinde, tüm olgularda anti-tüberküloz tedavi ile sağkalım elde edildi. Sonuç: Ekstrapulmoner tüberküloz çeşitli klinik başvuru tablolarıyla karşımıza çıkabilir. Cerrahi girişimler, doku tanısı elde etme ve hastalığın yol açtığı komplikasyonları gidermede önemli rol üstlenir.

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