Role of Diagnostic Laparoscopy in Case of Koch’s Abdomen with Intestinal Obstruction: An Observational Study

Abstract

Background & Aims: The diagnosis of abdominal tuberculosis has always been a challenge to the physician. The clinical presentation is subtle with many vague symptoms and nonspecific signs. We did this study to find the various diagnostic findings in a case of chronic abdominal pain and find out the efficacy of laparoscopy in diagnosing Koch’s abdomen. Materials and Methods: A prospective observational study was conducted on patients attending surgery department from Nov-2020 to Nov-2021 having clinical and radiological diagnosis of abdominal tuberculosis. Total 59 patients of suspected abdominal tuberculosis underwent diagnostic laparoscopy and started on anti-tuberculosis treatment. Result: The most common presenting symptom was abdominal pain present in 35 patients (59.32%). In CT scan, 31 of them were suggestive of abdominal tuberculosis and seven were inconclusive. Only 37 of them had positive (62.71%) histology for tuberculosis and 22 were negative (37.28%). The PPV and NPV of CT scan was 77.42% (95% CI=60.19-88.61%) and 85.71%% respectively. Out of 27, 20 mesenteric lymph nodes had positive histology for tuberculosis. 29 patients had caseating granuloma and 12 had non-caseating granuloma. All 18 histology negative patients had nonspecific chronic inflammation with reactive lymph nodes. Peritoneal fluid was aspirated and sent for CBNAAT from 30 patients (50.84%). 10 were positive (33.33%) for tuberculosis gene and 20 (66.33%) were negative. Conclusions: Performing laparoscopy in the majority of patients with suspected abdominal tuberculosis is a clinically rewarding idea. It has a high yield to establish the diagnosis of abdominal tuberculosis (65.78%) by sampling macroscopically pathological tissues. Keywords: Koch’s abdomen, Diagnostic laparoscopy, Koch’s abdomen