Usefulness and Limitations of Laparoscopy in the Diagnosis of Tuberculous Peritonitis

Abstract

The value of laparoscopy in the diagnosis of tuberculous peritonitis was determined in 32 patients diagnosed histologically as having the condition. In 27 (85%) patients the diagnosis was obtained by laparoscopy combined with peritoneal biopsy. In five patients in whom laparoscopy was unsuccessful, the diagnosis was established by laparotomy. The visually established diagnosis was unreliable and needed histological confirmation. In the ascitic form of tuberculous peritonitis laparoscopy was a safe method which enabled a definitive diagnosis. In the fibroadhesive form of tuberculous peritonitis laparoscopy was risky and gave insufficient information, the diagnosis easily being established by laparotomy.

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

“…Five of the patients with adhesions (6%) were converted to laparotomy in our series and 16% of patients were converted to laparotomy due to adhesions in the series by Mimica et al 69 The most tuberculosis positive histology specimens are intra / retro peritoneal mass (82%), tubercles (80%) and lymph nodes (77%). There was no positive histology at all for tuberculosis in appendix or gall bladder specimens.…”

“…The conversion rate is acceptable in our patients due to the nature of the disease. Mimica et al 69 reported 16%…”

“…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.…”

“…There have been interests expressed in the use of laparoscopy to establish the diagnosis of abdominal tuberculosis. 21,69,70,71,72,73 Table 2 shows the different laparoscopic series with their diagnostic yields. The risk involved with laparoscopy is low but there is a definite incidence of complications which may be significant.…”

Tubercular bowel perforation: what to do?

“…Laparoscopies have been hailed as being particularly useful for obtaining quality samples for microbiological analysis. However, laparoscopic investigation of tuberculous peritonitis has failed in 1% to 16% of cases, [29,36,37] and is not without risk. The major complication is intestinal perforation, [38,39] which was originally thought to be more common in the fibro-adhesive form.…”