Treatment of Abdominal Wall Infected Sebaceous Cyst with Tuberculosis
The treatment for an abdominal wall infected sebaceous cyst diagnosed with tuberculosis requires both surgical excision of the cyst and a complete standard anti-tuberculosis drug regimen consisting of isoniazid, rifampin, pyrazinamide, and ethambutol for 6 months. 1, 2
Surgical Management
The surgical approach should include:
- Complete excision of the infected sebaceous cyst along with a rim of healthy tissue 3
- Removal of all infected and necrotic tissue to prevent recurrence
- Collection of tissue samples for histopathological examination and culture for M. tuberculosis
- Consideration of primary closure if the wound is clean and not extensively infected 3
Surgical Considerations
- For abdominal tuberculosis, resection of the affected area is preferred over simple drainage 1
- The procedure can be performed under local or general anesthesia depending on the extent of infection and patient factors 3
- Sutures are typically removed after 14-21 days depending on the location and healing progress 3
Medical Management
Following surgical excision, anti-tuberculosis therapy must be initiated promptly:
Initial Phase (First 2 Months):
Continuation Phase (Next 4 Months):
Monitoring and Follow-up
- Monthly clinical evaluations to assess treatment response and monitor for adverse effects 2
- Laboratory monitoring for drug toxicity (liver function tests, visual acuity if on ethambutol)
- Wound inspection for proper healing and signs of recurrence
- Cultures should be obtained to confirm drug susceptibility 1
Special Considerations
Drug Resistance
- If drug resistance is suspected based on patient history or local epidemiology, never add a single drug to a failing regimen 1
- For multidrug-resistant TB, at least 3 drugs to which the organism is susceptible should be used 1
- Consultation with a TB expert is recommended for drug-resistant cases 1
Immunocompromised Patients
- For HIV-infected patients, treatment duration may need to be extended to 9 months 1
- Daily therapy is preferred over intermittent regimens in HIV-infected patients 2
Important Pitfalls to Avoid
- Misdiagnosis: TB can mimic common conditions like infected sebaceous cysts; always consider TB in endemic areas 4
- Inadequate surgical excision: Incomplete removal may lead to recurrence
- Premature discontinuation of anti-TB medications: Complete the full course to prevent relapse and drug resistance 2
- Failure to monitor for drug toxicity: Regular follow-up is essential to detect adverse effects early
- Delayed treatment: Prompt initiation of anti-TB therapy after diagnosis is crucial for successful outcomes 5
Evidence-Based Rationale
Abdominal tuberculosis is the most common extra-pulmonary form of TB, with the ileocecal region being the most frequently affected site 1. When TB presents as an infected sebaceous cyst in the abdominal wall, it requires both surgical intervention and medical therapy for complete resolution 5, 6.
The combination of surgical excision and standard anti-TB therapy has shown excellent outcomes in managing abdominal TB, with significant reduction in morbidity and mortality when treatment is initiated promptly 5, 6.