Laparoscopic Resection for Intestinal Obstruction Due to Koch’s Stricture

By Dr. Dharmesh Dhanani, Advanced GI & Laparoscopic Surgeon

Clinical Presentation

A 20-year-old male presented to the emergency department with:

  • Acute abdominal pain
  • Persistent vomiting
  • Abdominal distension
  • Inability to pass flatus or stools

    On examination and imaging, features were consistent with acute intestinal obstruction, likely due to a distal small bowel stricture.

Case Overview

  • Patient: 25-year-old male
  • Incident: Accidental air gun discharge caused penetration of a metal hook (Khili) through the abdominal wall
  • Initial Assessment: The patient arrived in a hemodynamically unstable condition with signs of internal bleeding.

Investigations

  • X-ray: Dilated small bowel loops with air-fluid levels
  • CT Abdomen: Single long-segment stricture in distal ileum with proximal dilation
  • Labs: Mild leukocytosis; no evidence of perforation or peritonitis

Surgical Intervention

Procedure: Laparoscopic Small Bowel Resection with Primary Anastomosis

  • Intraoperatively, a 20 cm strictured segment of small intestine was identified with signs of chronic inflammation.
  • Affected bowel was resected laparoscopically.
  • A side-to-side functional end-to-end anastomosis was performed.
  • No evidence of active perforation, ascites, or peritoneal tubercles was seen.

Histopathological Findings

The resected specimen was sent for biopsy.
 Histopathology Report: Granulomatous inflammation with caseating necrosis suggestive of intestinal tuberculosis (Koch’s stricture).

Postoperative Course & Outcome

  • Uneventful recovery
  • Oral intake resumed by Day 2
  • Discharged on Day 4 with anti-tubercular treatment (ATT) initiated in consultation with infectious disease specialist
  • Follow-up at 2 weeks: Well healing wound, no GI complaints

Discussion

Intestinal tuberculosis is a common but often underdiagnosed cause of bowel stricture in endemic regions. It may present with vague abdominal complaints or acute obstruction.

Key Takeaways:

  • Laparoscopy allows both therapeutic resection and diagnostic tissue sampling
  • Minimally invasive surgery ensures quicker recovery and lower morbidity
  • A high index of suspicion is crucial in young patients with unexplained strictures
Picture of Dr Dharmesh Dhanani

Dr Dharmesh Dhanani

MS, FNB (Minimal Access Surgery), FACS, FALS, FMAS, FAIS Consultant Gastrosurgeon, Bariatric & Laparoscopic Surgeon
Picture of Dr Dharmesh Dhanani

Dr Dharmesh Dhanani

MS, FNB (Minimal Access Surgery), FACS, FALS, FMAS, FAIS Consultant Gastrosurgeon, Bariatric & Laparoscopic Surgeon