Dr.Ravinder Pal Malhotra
Director & Head, Center for Liver Transplant and Gastro Sciences, Saroj Super Specialty Hospital, Delhi
Tuberculosis (TB) is an infectious disease caused by acid fast bacterium (AFB) Mycobacterium tuberculosis (M.tb). India has a particularly high incidence of TB in the world. The global impact of TB disease is also significant. Any region of the body can be affected by TB. Tuberculosis of stomach is relatively rare and tubercular aortitis is even rarer; however, tubercular aorto-gastric fistula is an extremely rare entity. The primary objective of this study is to report an extremely rare case of a middle aged female presenting with aorto-gastric fistula, who is the only surviving patient in the world after such surgery to the best of the author’s knowledge, the complex surgical procedure performed and the postoperative management of such patient. In addition, the secondary objective is a comprehensive review of literature for aorto-enteric fistula, its definition, classification, manifestation, pathogenesis, diagnosis, imaging, treatment and outcome. Tuberculosis management has now been complicated with emergence of resistant strains, defaulters, immunosuppresed patients, post transplant patients and patients presenting with other co morbidities and challenges. It requires multidisciplinary management of intensivist, surgeon, radiologist and intervention radiologist. All such patients should be referred to dedicated units dealing with such patients. The medical management of such patients with anti-tubercular drugs is the direct way to manage such patients and decrease their secondary complications.
Keywords: Tuberculosis, fistula, aorto-gastric fistula, aortic fistula, gastric fistula, aortogastric, aortoenteric