Peritoneal tuberculosis: A persistent diagnostic dilemma, use complete diagnostic methods

Role of Laparoscopy in Diagnosis of Abdominal Tuberculosis

“…In our study, mesenteric lymphadenopathy was present in 50% of the patients; and peritoneal and mesenteric thickening in 60%. These figures correlated with Salgado Flores L, et al 23 as 50% and 58% respectively.…”

“…It was present in 48 cases (96%) in variable amount. Salgado Flores L, et al 23 reported the corresponding figureas 100%. Tarcoveanu E, et al 13 reported the corresponding figure as 89%.…”

Diagnosing peritoneal tuberculosis

“…Peritoneal tuberculosis is a form of abdominal tuberculosis that most often presents as an insidious progression of abdominal pain (50% to 100%) and distention due to ascites (40% to 73%) 1 8–11. Constitutional symptoms including weight loss (50% to 61%), fever (13% to 59%) and night sweats (6%) may also be present 1 8 11.…”

“…Making a direct microbiological diagnosis of peritoneal TB can be challenging, owing to suboptimal sensitivity of diagnostic testing, the paucibacillary nature of the disease and a dilutional effect of ascites 5 9. A Ziehl-Neelsen stain of the ascitic fluid is positive in 0% to 6% of patients, and culture positive in 16% to 58% of cases, though yield may be improved by centrifugation and culture of a large volume (1 litre) of ascites 1 9 10 12 14 17–20. Molecular diagnostics such as TB PCR are highly specific but lack sensitivity.…”

“…A peritoneal biopsy specimen is positive on acid-fast stain in 50% to 63% of cases, and culture is typically positive in about 70% of cases 3 12 14 18. Histopathological evaluation of the tissue may reveal the presence of caseating granulomas in 70% to 95% of patients as an essential diagnostic clue, while PCR of the tissue is positive in 25% to 70% of cases 3 8–10 12 14 17 18…”