Pitfalls of diagnostic laparoscopy in abdominal tuberculosis

Abstract

For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.

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

“…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.…”

“…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.…”

A rare cause of small bowel obstruction: Abdominal cocoon

“…It also further highlights the visual pitfall of diagnostic laparoscopic in erroneously diagnosing abdominal tuberculosis. 9 Moreover, careful surgical intervention with the use of anti-adhesive agents may prove to be of a long-lasting favorable outcome.…”

“…Diagnostic laparoscopy is well-known for its pitfalls in visually diagnosing abdominal TB without the histological confirmation. 9 Surgery is the main stay of treatment and it is often delayed due to delay in diagnosis especially in the absence of acute symptoms. During surgery, careful release of trapped small bowel loops from the 'cocoon' is mandatory together with release of adhesions between the bowel loops and the excision of the fibrous cover of the 'cocoon'.…”

Diagnostic Laparoscopy for Abdominal Tuberculosis: A Promising Tool for Diagnosis

“…Diagnostic laparoscopy prompts the diagnosis and can reduce the delay which can increase the morbidity and can lead to unnecessary laparotomies while improving the outcome [30][31]. Despite all the benefits, some limitations like a deceiving view leading to mis-diagnosis regardless of the experience of surgeon are mentioned by few studies [32][33][34][35].…”