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Case Study

A Case of Koch's Abdomen
Dr Pravin M Shah
Dr Sheetal

Abstract: Abdominal Tuberculosis is generally a disease of the adult population, occurs more often in females, with equal frequency in rural and urban population.
The ileocaecal region is involved in nearly half to two thirds of cases, colon and jejunum also being frequently involved. Approximately two thirds of cases are "primary" without evidence of any active or inactive pulmonary lesion.

The mechanisms of invasion are:

  1. Invasion by ingested organisms in the form of infected sputum.
  2. Haematogenous spread.
  3. Lymphatic spread.
  4. Direct spread from adjacent tissues.

Common Clinical Features:

  1. Abdominal colicky pain
  2. Low grade fever.
  3. Weight loss.

Other Symptoms:

  1. Nausea / Vomiting
  2. Flatulence/ Abdominal distension/ Borborygmi
  3. Anorexia
  4. Bowel disturbances- constipation/ diarrhoea.

Onset: acute or subacute obstruction with colicky pain, abdominal distension and/or vomiting depending upon the level of obstruction. Bleeding is uncommon.

Physical signs include tenderness in RIF (with ileo-caecal involvement) without a palpable mass or a fixed and tender lump may be found. Associated peritoneal disease may lead to muscle guarding or "doughy" feel.....

When Koch's abdomen comes to a homoeopathic physician http://www.njhonline.com/images/rtarrow.gif what would/should one do?

First: whether to accept the case or not?
Knowing the gravity of the disease and its possible complications à it would be a challenge to accept such a case, trusting the miraculous powers of homoeopathic remedies of our vast Materia Medica. If one has seen such a case being handled then the decision becomes easier. That is the reason d'etre of Journals, to make us aware of various kinds of difficult cases.

The Case:
Mrs XYZ 56, housewife came to us with CC of diarrhoea since 3-4 months accompanied by weight loss. Gastro-enterologist opinion and reports of investigations:


Hb-9.1 gm%

L - 20%


Hb-9.1 gm%

E - 01


N - 79%

ESR - 50 mm

BA Meal Follow Through Examination: Oesophagus: N. Early changes of gastritis and duodenitis noted. No hiatus hernia. Changes of mal-absorption pattern in small bowels extending up to the terminal ileum, secondary to Koch's infection. A long fixed tender appendix seen. The IC region otherwise normal except colitis in distal colon.
Based on above findings, she was advised AKT.

Homoeopathic Case Record
Name: Mrs XYZ came on 11/3/97
Age: 56 years Sex: F Religion: Jain
Diet: Vegetarian

Chief Complaints:





Since one year

Pain in abdomen
Burning in anus
Stool-large quantities 4-5 times a day; Loose, watery

< before stool
> after passing stool

mouth ulcers
http://www.njhonline.com/images/toparrow.gif burning

Associated Complaints

1. (R) hand
since 15 days

Pain ++

< morning
> pressure

Physical Generals:

Appetite: Good
Cravings: N S
Aversions: N S
Stool: c/c
Urine: (N)
Perspiration: partial - occ on forehead.

Thermal state:
Bath = cold water
Covering = does not require C2H3
FAN must Prefers winter season
Sleep: sound
Dreams: unremembered, routine M/H/O: menopause - 5 years back Deliveries: 2 FTND, 1 LSCS

Assistant's Notes:
Patient's husband is already our patient. During the interview, she comes across as a jovial person, with good smile. She was absolutely relaxed during the interview.
But she described herself as short-tempered and impatient. If angry, she has to burst you; unless and until she expresses herself she is not comfortable. But, once she comes out with what she has to say, she calms down immediately.

She is a little anxious by nature even over trifles. She has a daughter who is mentally retarded. This makes her anxious about the future.

She is indecisive and hasty. After taking a decision regarding anything, she would later on repent, "What if I had done this instead of that and so on".
She was little emotional during the interview; wept while relating her daughter's health. Her one fear is "fear of death" After her diagnosis, she constantly feels that she will die and what will happen to her daughter, if she dies.
She does not like to be alone, prefers meeting people and talking to them.
Now came the tough task for the physician - the Remedy!!
The entire case physical as well as mentals was not so characteristic so as to come to one particular remedy. But one physical was so characteristic that it could not be missed.

Burning in Anus < Before Stool
How many patients give us such symptoms, not related to the disease pathology and yet so characteristic!!
We decided to take that as an eliminating symptom:
Kent Repertory pg. 626
Rectum-Pain burning stool before
Remedies with 3 marks= 0
2 = Berb, Nat-m, 01nd, Rat, Sulph (Please check remedy names)
1 = Dios, Jug-c, Sabad, Verat.

Reflecting on the case: patient is

·         Irritable

·         Impulsive

·         Reserved

·         Sentimental

·         Has Fear of 'death'

·         C2H3

·         Perspiration - scanty

"Natrum-mur was the remedy which was the most similar remedy at that point in time!!
The understanding of susceptibility was moderate (not low-because in spite of the disease being present since 1 year, it had not progressed too much as to cause structural irreversible changes)

Patient was put on Nat-mur 200 3 P HS- 13/3/97 till 17/4/97. When Nat-m 1M repeated doses were started, there was initial response to the remedy, but the expected progress was not forthcoming. So the use of intercurrent Tub (current disease condition + F/H/O = Father (NIDDM) (TB), Brother (HT), Sister (HT) Tub 1M given on 28/7/97; the response was dramatic - the pain, the (F) of stools, the (C) of stools started improving. Patient started putting on weight gradually with increased appetite.

After 1 year of treatment with homoeopathy (NO AKT at all) the patient was referred back to gastroenterologist for opinion. The response was most encouraging. He could not believe his eyes. The changes in Ba enema were all vanished. The X-rays displayed a perfectly (N) GIT lining. Nothing else was left to expect?

At present patient continues with Homoeopathic Rx for minor complaints. The fear of 'death' is gone with the disease thanks to the power of Homoeopathic remedies.