The role of laparoscopy in diagnosis of abdominal tuberculosis

Abstract

confirming the diagnosis of abdominal tuberculosis. Methods: A prospective and retrospective study of 114 patients who underwent diagnostic laparoscopy for chronic abdominal pain with unsettled diagnosis between July 2007 and December 2012 was done. Abdominal tuberculosis was diagnosed in 46 of these patients. A descriptive analysis of data collected from case records of the patients was done to study the clinical characteristics, laboratory, radiological and histological findings along with usefulness of laparoscopy to confirm the diagnosis of abdominal tuberculosis. Results: Laparoscopy was performed in 114 patients of chronic abdominal pain with unsettled diagnosis. Peritoneal tuberculosis was diagnosed in 46 of them, characterized by presence of ascites, multiple whitish tubercles, fibrous bands and adhesions, strictures of small intestine, hyperemic edematous bowel loops or dense adhesions etc. Peritoneal biopsy confirmed the diagnosis in 28 of the 46 (60.86 %) patients. In 18 patients due to clinical impression, radiological findings and raised ascitic fluid ADA a therapeutic trial with antituberculosis treatment was given. All patients showed good response to antitubercular treatment. Thus laparoscopy provided positive diagnosis of tuberculosis in 46 patients with positive histology in 28 (60.86 %) and inferred diagnosis in 18 (39.13%) patients of abdominal tuberculosis. Conclusions: Laparoscopy is safe and helpful in the diagnosis of peritoneal as well as intestinal tuberculosis. In patients suspected to have abdominal tuberculosis early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.