Tuberculous peritonitis the value of laparoscopy in diagnosis

ABSTRACT

Of 93 patients with a provisional and laparoscopic diagnosis of tuberculous peritonitis, 91 [97.8%] patients had tuberculous peritonitis while 2 [2.2%] had peritonitis carcinomatosa. Out of the 91 tuberculous patients, 39 [42.9%] had a highly suggestive clinical picture of tuberculous peritonitis in the form of subacute onset of abdominal swelling and ascites, in addition to fever, abdominal pain, abdominal tenderness and a tense slightly expanded abdomen; 97% of the patients had elevated E.S.R. Associated pleural effusion was present in 15.4% and pulmonary tuberculosis, in 2.2% of the patients. Thirty three [54%] had noncaseous tuberculous granuloma while 20 [32.0%] had caseous ones. Bacteriological studies for Mycobacterium tuberculosis, were positive in 76.6% of the patients and guinea pig inoculation was the most sensitive method for detection of Mycobacterium tuberculosis followed by culture and lastly by smear. Laparoscopy suggested the diagnosis in 96.7% of patients with final diagnosis of tuberculous ascites. Laparoscopy can be considered the technique of choice for diagnosis of tuberculous peritonitis. Visual diagnosis though highly informative, does not preclude sampling for bacteriologic and histopathologic confirmation. A significant and progressive improvement was reported in patients attending the follow-up after antituberculous therapy