Does laparoscopy have a limited role in diagnosis of fibroadhesive tuberculous peritonitis?

The information on the limitations of laparoscopy (LP), particularly in the diagnosis of fibroadhesive form of tuberculous peritonitis (TP) is insufficient. Some reports suggested the risk and insufficient information obtained from LP in the diagnosis of fibroadhesive tuberculous peritonitis (FTP). The objectives of this study were to determine the usefulness and limitations of LP in the diagnosis of FTP and ascitic TP. The clinical and laparoscopic features of 64 patients with TP were analyzed. FTP was observed in 44 patients (68.8%) comprising 14 cases with small tubercles with thin fibrous adhesions in the peritoneum, 28 cases with large tubercles or confluent nodules with severe adhesions of intestinal loops omentum, and abdominal walls, and 2 cases with caseous material in the abdominal cavity with multiple peritoneal adhesions. Ascitic TP with multiple white nodules were found in 20 patients (31.2%). Laparoscopic diagnosis was confirmed by intralaparoscopic biopsies in all patients. No complications or limitations were found. Our study revealed that laparoscopy was a safe, accurate, and uncomplicated method for diagnosis of FTP and ascitic TP. It gave sufficient information, so diagnostic laparotomy was unnecessary.

Histologic and cytologic study of multiple endoscopic biopsy of gastric ulcer.

A prospective study was carried out on 50 patients with an endoscopicaly proven gastric ulcer. In each patient, multiple endoscopic biopsy specimens were taken for histologic and examinations. In 44 group-A patients with endoscopicaly benign gastric ulcers, both histologic and cytologic examinations failed to discover an overlooked malignant ulcer. This did not imply, however, that both methods were useless in this respect, as the number of patients studied was not very large. In 6 group-B patients in whom a malignant gastric ulcer was evident of otherwise suspected endoscopicaly, both histologic and cytologic examinations did not appear to offer any extra benefit over that of the histologic examination alone. A false-positive reading for malignancy was encountered with the cytologic interpretation in 1 patient of groups B. The authors thus consider that for most endoscopic units in Thailand, multiple endoscopic biopsy sampling for a histologic study with or without a cytlogic study may be reserved only for those gastric ulcer cases in which there is an endoscopic suspicion of an underlying malignancy. The cytologic examination may be implemented only if such facility is readily available. Finally, the “touch-smear” technique for collecting a cytologic specimen would be a convenient and reliable method to be employed.