感染症と治療ジャーナル

抽象的な

Diagnostic Laparoscopy in the Diagnosis of Abdominal Tuberculosis

Bilal A Rather

Background: Abdominal tuberculosis presents with vague symptoms and marked by a delay in establishing a diagnosis. Present study was done to compare the utility of Computerised Tomography abdomen with diagnostic laparoscopy in the diagnostic algorithm of Abdominal Tuberculosis.

Method: This study enrolled 25 patients who underwent a operative procedure in the form of a diagnostic laparoscopy or explorative laparotomy. In these patients intra-operative findings were noted and tissue send for histopathological examination.

Results: The commonest findings observed was presence of tubercles over peritoneal surface. Tubercles over gut and peritoneum were present in 72% and on omentum in 32%. Other common findings were adhesions (56%), ascitis (52%), cocoon abdomen was present in 28%. Other findings were omental thickening, visceral and parietal peritoneum thickening, loculated collection, ileo-caecal mass, gall-bladder mass, mesenteric lymphadenopathy and ileal strictures.

Conclusion: Computerized Tomography has a better sensitivity for omental thickening, retro peritoneal lymphadenopathy, bowel wall thickening, omental stranding and mesenteric thickening. Diagnostic laparoscopy was found to have better sensitivity for detection of tubercles, particularly those less than 5 mm, adhesions, matting of gut (cocoon abdomen) and ileal strictures while these findings were easily picked up on laparoscopy. Both these diagnostic modalities had nearly equal sensitivity towards findings like intra-abdominal collection, loculated or generalised and peritoneal thickening.