Role of Diagnostic Laparoscopy in the Diagnosis of Abdominal Tuberculosis

Abstract

Introduction: Tuberculosis, a disease of mankind since time immemorial still continues to be a global health concern. In addition, the prevalence of drug-resistant tuberculosis is increasing worldwide. Tuberculosis (TB) has an incidence of 211 cases per 100,000 population and adds about 2.8 million cases to the total pool every year. Any part of the GI system may be infected, although the ileum and colon are common sites. Abdominal tuberculosis which involves the bowels, peritoneum, lymph node or solid viscera, constitutes up to 12% of extra pulmonary tuberculosis. In the past the diagnosis of abdominal tuberculosis was dependent on either blind peritoneal biopsy or visual findings on diagnostic laparotomy. However with the ever increasing experience with laparoscopy direct visualisation of the peritoneal cavity and simultaneous biopsy of doubtful lesions became possible. Various studies have proven laparoscopy to be a rapid, safe, and most specific procedure for the diagnosis of abdominal tuberculosis.
AIMS AND OBJECTIVES: To study the importance diagnostic laparoscopy in the diagnosis of abdominal tuberculosis.
MATERIALS AND METHODS: This was a prospective study to evaluate the importance /role of laparoscopy in diagnosis of abdominal tuberculosis. It was conducted in the department of general and minimally invasive surgery SKIMS, Srinagar over a period of two years. A total of 48 patients were subjected to diagnostic laparoscopy. Informed consent was taken from all the patients. Inclusion criteria were patients with abdominal pain who had remained undiagnosed despite exhaustive evaluation with biochemical, molecular and imaging techniques. The patients with uncontrolled coagulopathy and severe cardiopulmonary disease were excluded. Doubtful lesions in peritoneal cavity were routinely biopsied for histopathological diagnosis and ascitic fluid if present was taken for biochemical, cytological, microbiological (AFB Staining) and molecular analysis (CB NAAT).
Results: In our study group there were 31 (64.58%) males and 17 ( 35.41 %) females. The most common symptom was pain abdomen 100% followed by fever 29.16% bloating 27.08% weakness 20.83%weight loss 16.6%and diarrhoea 8.3%.The most common laparoscopy finding among the patients was adhesions(14)(29.16%), abdominal TB(12)(25%), chronic recurrent appedicitis(11)(22.9%), pelvic inflammatory diseases(3)(6.25%) and metastatic peritoneal disease(2)(4.16%). Negative diagnostic laparoscopy (6)(12.5%). Out of 12 patients diagnosed as abdominal tuberculosis on diagnostic laparoscopy only 2 had ascitic fluid CB NAAT positive while none of the patients tested positive on AFB staining of ascitic fluid. Also none of the patients had shown peritoneal lesions less than 5mm on CT. No complications pertaining to diagnostic laparoscopy were observed in our study group.
Conclusion. From our study we conclude that diagnostic laparoscopy is a very effective and robust diagnostic modality to make a very reliable diagnosis in patients wherein the other diagnostic modalities have failed to reach a conclusive diagnosis. We also suggest a low threshold for diagnostic laparoscopy in cases where tuberculosis is suspected so that an early diagnosis is done and an appropriate antitubercular regime is started for better outcome and minimise complications related to delayed diagnosis.