Laparoscopic diagnosis of peritoneal tuberculosis

Abstract

Laparoscopy is safe and readily establishes the diagnosis of peritoneal TB.

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

“…Gastrointestinal tuberculosis was reported to be 37% -50% of abdominal tuberculosis in the 70's and 80's. 16,25 There was no patient with documented luminal intestinal tuberculosis in our series and most of our patients presented with abdominal lymphadenopathy (70%), which was similar to the series by Clarke et al 17 Ramesh et al 80 Tubercles were present only in 25% of our patients, whereas Nafeh et al 78 had 58% and Al-Mulhim et al 21 had 91% of their patients with tubercles. Though the number of specimen was small, the 2 nd highest positive result was from the tubercles (80%).…”

“…Our findings were little different from that of Nafeh et al 78 , who had caseating granuloma in 34% and non-caseating granuloma in 56% cases; though more or less similar to that of Al-Mulhim et al 21 , who had caseating granuloma in 67% and non-caseating granuloma in 14% cases, neither of these two studies mentioned about presence of AFB in their specimens and Krishnan et al 71 had no AFB present in their ascitic fluid.…”

“…102 There were numerous publications with interest in laparoscopy in the diagnosis of abdominal tuberculosis, but the biggest problems with these publications are: almost all of them are retrospective and small sample size, most of their patients had wet (ascitic) type of abdominal tuberculosis and none of the patients were HIV positive or not mentioned. 21,70,71,72,73 In comparison most of our patients are HIV positive and almost of them had dry (plastic) type of tuberculosis.…”

“…Fifteen of them had non-specific chronic inflammation (18%) and one had no pathology (1%). Al-Mulhim et al 21 had 19% non-specific chronic inflammation, whereas Nafeh et al 78 had 3% of their patients with nonspecific chronic inflammation and 7% with unsatisfactory biopsy.…”

“…There have been interests expressed in the use of laparoscopy to establish the diagnosis of abdominal tuberculosis. 21,69,70,71,72,73 Table 2 shows the different laparoscopic series with their diagnostic yields. The risk involved with laparoscopy is low but there is a definite incidence of complications which may be significant.…”