Role of laparoscopy in the diagnosis and management of abdominal tuberculosis

Abstract

Background: Tuberculosis continues to be a common disease in Iran and one of its presentations is abdominal tuberculosis. Histopathological confirmation of abdominal tuberculosis is difficult because of suboptional, noninvasive access to the pathology. Laparoscopy provides minimally invasive access to the peritoneum. AIM: The aim is to evaluate the role and importance of laparoscopy in the diagnosis of tuberculous peritonitis (TP). Materials and Methods: A retrospective study on laparoscopy in Razi hospital of Rasht (in northern Iran) over a period of ten years showed that diagnostic laparoscopy was performed in 290 patients with abdominal pain, with or without ascites. Most cases revealed malignancy and we found 28 cases of abdominal tuberculosis. Results: Macroscopic findings of TP were whitish granulations over both peritoneal layers, inflammatory adhesions on the visceral or parietal surface, thickening, hyperemia and retraction of the greater omentum and stalactic band which is characteristic of TP. Pathology confirmed TP in 28 cases and all patients had excellent response to medical therapy. Conclusion: Although other diagnostic methods of TP such as imaging, culture of ascitis and polymerase chain reaction (PCR) are used today, laparoscopy with tissue biopsy provided rapid and correct diagnosis of abdominal tuberculosis.