Laparoscopic diagnosis of tuberculous ascites

We report 14 patients with tuberculous peritonitis presenting as persistent and exudative ascites. We found a primary site of tuberculous infection in only 10% of the patients. PPD test was positive in 9 patients. Ascitic fluid showed a protein content in excess of 3.5 g/dl. and more than 300 cells/mm3, mainly lymphocytes, in all patients, Ziehl stain and the culture for Tb. bacilli were negative in all cases. The confirmatory diagnosis was made by laparoscopy and peritoneal biopsy. Good views were obtained on all occasions, and there was no morbidity. Appearances were similar in all cases. Multiple white tubercles were scattered over the parietal and visceral peritoneum. filmy adhesions were present. Four patients had cirrhotic liver disease confirmed by laparoscopy. The biopsy specimen showed caseating granulomata, and the auramine stain was positive in four cases. We conclude that laparoscopy and biopsy is a safe and effective method of obtaining an early diagnosis in patients with tuberculous ascites, especially if they also have cirrhosis.