THE FREQUENCY OF PERITONEAL TUBERCULOSIS USING DIAGNOSTIC LAPAROSCOPY IN CLINICALLY SUSPECTED CASES

Abstract

Abstract:

Introduction:

Diagnostic laparoscopy allows the visual examination and documentation of intra-abdominal organs in order to detect any pathology. It is an important tool for final minimally invasive exploration of patients with abdominal tuberculosis, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations.

Objective:

To determine the frequency of peritoneal tuberculosis using diagnostic laparoscopy in clinically suspected cases of peritoneal tuberculosis.

Study Design:

Cross sectional survey.

Setting:

The study was conducted in all the four Surgical Wards on surgical floor of Mayo Hospital Lahore.

Duration of Study with Dates:

Six months (1^st July 2009 to 31^st December 2009).

Material and Methods:

35 patients aged between 13-60 years with clinical suspicion of peritoneal tuberculosis were selected. The patients underwent the procedure accordingly. Per operative diagnosis of peritoneal tuberculosis made on the basis of presence of any or all of the operative (laparoscopic) findings such as multiple peritoneal adhesions, fibrous bands, whitish peritoneal tubercles, omental thickening and ascites. Diagnosis was confirmed with histopathology of peritoneal tissue biopsy. Also the biochemical analysis and culture sensitivity of ascetic fluid was routinely performed if any ascites is present.

Results:

Out of 35 patients, 40% were males and 60% females with mean age of 24.91±6.69 years. The laparoscopic findings of peritoneal tuberculosis were whitish peritoneal tubercles (57.2%) peritoneal adhesions (28.6%), ascites (17.2%), omental thickening (14.3%), fibrous bands (11.4%) and swollen edematous appendix (5.7%). Eighty percent were labeled with diagnosis of peritoneal tuberculosis on basis of diagnostic laparoscopy. These patients were confirmed to have peritoneal tuberculosis on histopathology of tissue biopsy.

Conclusion:

Diagnostic laparoscopy is useful in patients with suspected peritoneal tuberculosis. It helps in diagnosis by allowing the direct visualization of gross findings as well as collection of histopathological specimens. It also helps by reducing the number of unnecessary laparotomies and avoiding delays in the diagnosis and treatment.

Key words:

Frequency, Peritoneal tuberculosis, Diagnostic laparoscopy.