Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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376 Surgery and Healing in the Developing World
A
B C
Figure 21. A) Tuberculous abscess of the cervical spine destroying the third cervical
vetebra and causing quadriplegia. B) After drainage of the abscess, traction, and fusion
of the spine. C) Recovering from quadriplegia.
lying cause of sinuses from a number of organs, bones, joints, etc. Sinuses may be
treated by opening the tract for better drainage and by curetting the lining of the
tract to remove granulation tissue. A fistula is an abnormal communication between
two epithelial surfaces such as the bowel and the skin. Fistulas are usually caused by
perforation of a segment of bowel with recovery from the acute infection and persistent
draining from the perforated site into another hollow viscus or onto the skin.
Fistulas require management of the site of perforation by open surgery. This requires
skill and experience.
Tuberculosis
Tuberculosis is resurgent and becoming the scourge it once was, even in
wealthy communities. It may mimic almost any other serious acute or chronic
disease and therefore should be considered in the differential diagnosis of a wide
variety of clinical problems. The presence of chronic cough, especially with bloody
sputum, along with typical chest X-ray findings will alert us to the possibility of
tuberculosis in some other part of the body. However, many patients present with
tuberculosis of the GI tract, the GU tract, or a bone or joint without the pulmonary
symptoms so we may miss or delay the diagnosis and treatment. Timely diagnosis
and appropriate treatment are important to prevent death or severe disability. Even
patients with Pott’s paraplegia may recover if the tuberculous abscess compressing
the spinal cord is drained (Fig. 20). Such patients should not be abandoned without
an attempt to drain the abscess (Fig. 21 A,B,C). This requires experience.