Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period.

Abstract

(Table II).Haematological investigations (n= 145) showed a mean haemoglobin concentration of 11 g/dl (range 6-15 g/dl), a mean total white cell count of

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…We found that leucocytosis was more common than leucopenia (22% vs 15%) which was similar to that reported by Manohar et al 18 in the pre HIV era in Durban.…”

“…78,81 Fever was less common in our series (24%) than in others (46% to 92%). 78,79,80 Ascites was present in 94-95% of patients in some of the series in the past 18,78 and in 61-65% of patients in some of the recent series, 56,83 …”

“…15 Over the last three decades a number of audits of abdominal tuberculosis have been published from Southern Africa. 16,17,18,19 However most of these audits are from pre-HIV era, and the relevance of these findings in the current high HIV disease prevalence is uncertain. It has been reported that hospital prevalence of HIV infection among adult surgical population is up to 39% in South Africa.…”

“…Peritoneal biopsy gives a better diagnostic value than ascitic fluid analysis alone. 18 Blind percutaneous peritoneal biopsy used to be under taken with local anaesthesia with varying degrees of success. Peritoneal biopsy was first performed by Donohue in 1959 using Vim Silverman needle and later Abrams and Cope needles were used.…”

“…The role of blind percutaneous biopsy is limited in the cases of plastic (dry) type of abdominal tuberculosis which currently predominate. 18,62,69 The difficulty in confirming the diagnosis, the considerable morbidity and mortality associated with formal laparotomy in patients with abdominal tuberculosis and HIV co-infection, and the reluctance to embark on poorly defined empirical therapy have generated interest in the use of laparoscopy to obtain specimens for histological and microbiological assessment. 17,56,61 The advent of laparoscopy has allowed surgeons to visually inspect the abdominal cavity and take biopsies with minimal morbidity.…”