Laparoscopic Diagnosis of Peritoneal Tuberculosis

Abstract

Peritoneal tuberculosis is a form of abdominal tuberculosis that involves the parietal and visceral peritoneum, the omentum, and the intestinal mesentery. The 3 types of peritoneal tuberculosis are (1) the wet type, which is noted in 90% of cases and is usually associated with ascites; (2) the dry type, which is associated with adhesions; and (3) the fixed fibrotic type, which is associated with omental thickening, loculated ascites, and matted bowel loops [1Bhargava D.K. Shriniwas N.V. Chopra P. et al.Peritoneal tuberculosis: laparoscopic pattern and its diagnostic accuracy.Am J Gastroenterol. 1992; 87: 109-112PubMed Google Scholar]. Peritoneal involvement is caused by hematogenous spread, lymphatic spread, or direct spread from tuberculous salpingitis [2Abid H. Charif I. Mellouki I. et al.Role of laparoscopy in diagnosis of peritoneal tuberculosis (about 414 cases).Open J Gastroenterol. 2013; 3: 205-207Crossref Google Scholar]. There is often a delay in diagnosis because of vague and nonspecific symptoms. The differential diagnosis for peritoneal tuberculosis is disseminated carcinomatosis, primary peritoneal serous carcinoma, and peritoneal seeding by ovarian/fallopian tubal papillary serous carcinomas. Diagnostic laparoscopy with tissue biopsy is the gold standard for the diagnosis of peritoneal tuberculosis [1Bhargava D.K. Shriniwas N.V. Chopra P. et al.Peritoneal tuberculosis: laparoscopic pattern and its diagnostic accuracy.Am J Gastroenterol. 1992; 87: 109-112PubMed Google Scholar, 2Abid H. Charif I. Mellouki I. et al.Role of laparoscopy in diagnosis of peritoneal tuberculosis (about 414 cases).Open J Gastroenterol. 2013; 3: 205-207Crossref Google Scholar]. Typical laparoscopic findings of peritoneal tuberculosis are (1) multiple yellow-white tubercles scattered all over the visceral and parietal peritoneum, (2) omental thickening with ascites, (3) fibrous bands extending from the parietal peritoneum to the visceral peritoneum, and (4) an abdominal cocoon with a matted small bowel Fig. 1, Fig. 2, Fig. 3, Fig. 4.Fig. 2Omental thickening with straw-colored ascites.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Fibrous bands from the parietal to visceral peritoneum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 4An abdominal cocoon with a matted small bowel.View Large Image Figure ViewerDownload Hi-res image Download (PPT)