Laparoscopy in suspected abdominal tuberculosis is useful as an early diagnostic method

Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis.

A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6-year period, analysing its usefulness in establishing a histological diagnosis.

From May 1999 to April 2005, 131 patients underwent diagnostic laparoscopies in our institution, of which 41 patients had unknown aetiologies for ascites or abdominal pain. This subset of patients had been investigated for suspected abdominal tuberculosis with biochemical tests of serum and ascitic fluid; ultrasound and computed tomography scanning, upper and lower gastrointestinal endoscopies and contrast series, before being considered for diagnostic laparoscopy. None had manifest extra-abdominal tuberculosis. At laparoscopy, 39 of these patients (95%) had peritoneal nodules. Frozen-section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 33 patients (80%) whereas metastatic adenocarcinoma was reported in 6 (14%). Permanent sections confirmed the diagnosis of tuberculosis in all 33 patients. Only 2 (5%) patients had no findings on laparoscopy; nevertheless, on continuing follow up, no sinister diagnoses were made for these patients.

In patients suspected to have abdominal tuberculosis without evidence of extra-abdominal disease, early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive work-up may hence be averted by a timely laparoscopy and early treatment can be instituted.