Indication for peritoneal biopsy in tuberculous peritonitis

Pooled analysis of 163 published tuberculous peritonitis cases from Turkey

“…Because it may have features similar to malignancy and bacteriologic confirmation is difficult and timeconsuming, tuberculous peritonitis is usually diagnosed histopathologically (7)(8)(9)63). The results of our analysis were consistent with this, revealing that 102 patients (62.5%) were diagnosed histopathologically, 25 (15.4%) clinically, 9 (5.5%) bacteriologically, and 27 (16.5%) both bacteriologically and histopathologically.…”

“…Because laparotomy is invasive, it is only recommended in cases where laparoscopy is technically difficult. The consensus in many studies is that laparoscopy is the best diagnostic procedure for peritoneal biopsy (7,9,63). Laparoscopy allows the acquisition of suitable tissue while visually examining the peritoneum.…”

“…The characteristic appearance of the peritoneum on laparoscopy includes peritoneal thickening, hyperemia, and scattered yellowish nodules with central calcification. In studies of large patient groups, evaluation of the laparoscopic appearance of tuberculous peritonitis together with biopsy results had a sensitivity of 80%-94% (63). While waiting for bacteriologic confirmation, laparoscopic appearance and histopathologic examination can accelerate the diagnostic process and facilitate earlier initiation of treatment.…”

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…22,23 Tuberculous peritonitis was the commonest form of abdominal tuberculosis before the HIV era and had contributed to 0.1% to 1.5% of total cases of tuberculosis. 24 Peritoneal tuberculosis is classified conventionally into plastic (dry) and serous (wet) types. Mildly tender abdominal masses and doughy abdomen characterize the plastic type, ascites with or without signs of peritonitis characterize the serous type.…”

“…16,25 The hard criteria include: with reported sensitivity ranging from 0% to 6%. 24 The frequency of a positive culture for mycobacterium from small volumes of ascitic fluid has been less than 20% and it takes considerable time before results are available, although the positive rate can be improved by obtaining one litre of ascitic fluid concentrated by centrifugation. 34 The role of ascitic fluid adenosine deaminase activity (ADA) has been studied to differentiate tuberculosis from other causes of ascites.…”