Tuberculous peritonitis diagnosed using laparoscopy with assistance of a central venous catheter

Abstract

Laparoscopy with peritoneal biopsy is a tool for rapid and accurate diagnosis of tuberculous peritonitis (TBP). However, laparoscopic procedures are not risk-free; complications include injuries to the gastrointestinal tract and major blood vessels. The purpose of the present study was to introduce a novel method for safe and straightforward laparoscopic diagnosis of TBP. A case series of 12 patients with TBP diagnosed between October 2012 and November 2013 at our hospital is presented. The patients underwent a novel method of laparoscopy involving the use of a central venous catheter (CVC). The diagnosis was confirmed by biopsy and histology. The efficacy of the method for TBP diagnosis was evaluated by the time taken for the procedure and the rate of successful completion. The safety of the method was evaluated by recording all intra-and post-operative adverse events encountered. The mean age of the patients was 41 years and 33% were male. The mean operation time was 50.6 min and the median duration of hospital stay was 7 days. In all cases, diagnostic laparoscopy was successfully performed. Targeted biopsies were taken from all of the patients and revealed caseous granulomatous inflammation. All patients tolerated the procedure without significant bleeding or digestive tract perforation. In conclusion, the present case series demonstrated a novel method of diagnostic laparoscopy with CVC that is a feasible and straightforward procedure for TBP diagnosis.

Expression of Adenosine Deaminase and NLRP3 Inflammasome in Tuberculous Peritonitis and Their Relationship with Clinical Efficacy

“…It showed that ADA and NLRP3 in ascites of TP patients increased, suggesting that they might be involved in disease occurrence and development. In previous studies, we also discovered that ADA and NLRP3 were elevated in liver cirrhosis and gastroenteritis, which was associated with the results of this experiment [ 14 , 15 ]. It is well known that ADA, as a key enzyme of purine nucleotide metabolism in human body, can catalyze adenine nucleoside to produce inosine, generate hypoxanthine after nucleotide phosphorylase catalysis, and finally oxidized to uric acid and excreted in vitro [ 16 , 17 ].…”

“…After 2 months of treatment, the clinical efficacy of TP patients was evaluated [ 14 ]. Cured: clinical symptoms such as abdominal distension and pain, disappearance of abdominal tenderness and rebound pain, softness of abdominal muscles, and normal body temperature; markedly effective: clinical symptoms and signs of abdominal tenderness and rebound pain were obviously improved, and most of abdominal effusion was absorbed; effective: clinical symptoms and signs were relieved, and a small amount of ascites was absorbed.…”

Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

“…Previous studies done in patients with peritoneal tuberculosis also showed that laparoscopic appearance of peritoneum helped in making early diagnosis of tuberculosis and also initiation of anti-tuberculous treatment on basis of laparoscopic appearance alone 14 15 16 . The macroscopic diagnostic rate by laparoscopy is reported to be 78 % in one study 17 and 82 % in another study 18 .…”

Place de la laparoscopie dans le diagnostic de la tuberculose péritonéale dans une région endémique de la Tunisie

“…C'est une technique qui permet l'exploration directe de la cavité péritonéale et la pratique systématique de plusieurs biopsies. Sa spécificité et sa sensibilité représentent respectivement 93% et 98% [ 12 ]. Les aspects macroscopiques sont principalement représentés par les nodules péritonéaux dans (76 à 100% des cas), très évocatrices de tuberculose lorsqu´elles sont millimétriques faisant 0,5 à 2 mm de diamètre, blanchâtres, de tailles généralement égales parsemant le péritoine pariétal et viscéral, et par les adhérences péritonéales et l´inflammation du feuillet péritonéal en second lieu [ 13 , 14 ].…”