Fever of Unknown Origin Associated with Intrabdominal Lymphadenopathy, the Efficiency of Laparoscopic Biopsy

Abstract

Introduction: Prolonged fever is a difficult to diagnose febrile disorder appositely termed Fever of Unknown Origin. Abdominal lymphadenopathy mandates diagnostic set up with tissue biopsy in cases where percutaneous biopsy is not feasible or it fails to establish diagnosis. The aim of this study is to evaluate the safety, efficacy and diagnostic yield of laparoscopic lymph node biopsy in patients with Fever of Unknown Origin associated with intrabdominal lymphadenopathy. Materials and methods: The medical records of patients subjected to laparoscopic lymph node biopsy from August 2005 to December 2011 were revised retrospectively. Data collected from our prospective database included patient demographics, anatomical site of lymph node biopsy, operative time, conversion rate, morbidity, mortality, hospital stay and pathology results. Results: During the study period 32 patients were subjected to laparoscopic lymph node biopsy. The mean operative time was 40min. No intraoperative complications were recorded. There was no conversion to open. The root of the mesentery was the most common site of biopsy and non-Hodgkin lymphoma was the most common diagnosis. All patients had an uneventful recovery and the mean length of stay was 1.8 days. Diagnosis was successfully established in all but one patient where tissue sample was insufficient (diagnostic yield: 96.9%). Conclusion: Laparoscopic lymph node biopsy is a safe procedure with a high diagnostic yield. It can be performed on an outpatient basis and it should be offered in all patients with Fever of Unknown Origin associated with intrabdominal lymphadenopathy when percutaneous techniques are unsuccessful or not feasible.