Tuberculosis in children involves many organs and systems including lymphatics, lungs, CNS, GIT and genitourinary. Although the mainstay of treatment is medical, surgery has a definite role under specific circumstances. It is important to differentiate atypical mycobacterial
infection wherein surgery is the primary modality of treatment. The lung is most commonly involved in
tuberculosis and besides bronchoscopy, thoracic procedures range from tube
thoracostomy to decortication and lung resection. Neurotuberculosis constitutes almost half the cases of
extrapulmonary tuberculosis and
tuberculous meningitis (TBM) is the commonest type of CNS involvement.
Hydrocephalus is a late complication of TBM and shunt surgery is indicated when signs and symptoms of raised intracranial pressure persist despite adequate medical
therapy. Abdominal
tuberculosis could be peritoneal or gastrointestinal. Either form can complicate the other and each can present in acute, subacute or chronic form. Surgical
therapy is reserved for complications like
strictures, fistulae and GI bleed. Genitourinary
tuberculosis constitutes 15-20% of all extrapulmonary disease and
epididymitis is the most common manifestation in the males. Surgery is generally reserved for management of complications such as ureteral
strictures, perinephric
abscesses and nonfunctioning kidneys.