2005 Abstracts: Laparoscopy in Suspected Abdominal Tuberculosis Is Useful As An Early Diagnostic Modality
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Laparoscopy in Suspected Abdominal Tuberculosis Is Useful As An Early Diagnostic Modality
Prasad Krishna, Puneet Dhar, Dinesh Balakrishnan, Sudheer OV, Sudhindran Surendran, Amrita Institute of Medical Sciences, Cochin, Kerala, India
Background: Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying diagnosis.
Objective: To evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis Setting: Academically affiliated tertiary referral centre. Methods: A retrospective review was done, of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis, in a 5-year period, analysing its usefulness in establishing a histological diagnosis. Results: From May 1999 to October 2004, 37 patients underwent diagnostic laparoscopy for ascites or abdominal pain of unexplained origin. The patients had been investigated for suspected abdominal tuberculosis with microbiological and biochemical tests of serum and ascitic fluid; ultrasound and/ or CT scanning, upper and lower GI endoscopies and contrast series, before being referred for diagnostic laparoscopy. None had manifest extra abdominal tuberculosis. Four poor risk cases were performed under local anaesthesia. At laparoscopy, 33 patients (90%) had peritoneal nodules and 2 (5%) were detected to have previously undiagnosed cirrhosis. Frozen section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 28 patients (76%) whilst metastatic adenocarcinoma was reported in 5 (14%). Permanent sections confirmed the diagnosis in all 33 patients. One patient with previously diagnosed cirrhosis coexistent with tuberculosis had intraoperative bleeding from periumbilical variceal collaterals requiring a continuous suture. Two patients had persistent ascitic leak for upto 5 days. Follow up ranged from 3 months to 5 years, and did not alter the diagnoses in any patient. Only 2 (5%) patients had no findings on laparoscopy and no sinister diagnoses could be made for these patients on continuing follow up and investigations. There was no early mortality or significant morbidity on follow up. Conclusions and interpretations: In patients suspected to have abdominal tuberculosis without evidence of extra-abdominal disease, early laparoscopy may be very useful to establish a histological diagnosis with an acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive workup may hence be averted by a timely laparoscopy and early treatment can be instituted.
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