Sistema gastrointestinal y digestivo

Abstracto

Diagnostic Laparoscopy in Diagnosis of Abdominal Tuberculosis

Tariq A mir, Bilal A Rather, Tajamul Hasan, Mudasir Nazir, Zubair A Khuja

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

Method: This study enrolled 25 patients who underwent an operative procedure in the form of a diagnosticlaparoscopy or explorative laparotomy. In these patients intra operative findings were noted and tissue sends forhistopathological examination.

Results: The commonest findings observed were presence of tubercles over peritoneal surface. Tubercles overgut 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 parietalperitoneum thickening, loculated collection, ileo caecal mass, gall bladder mass, mesenteric lymphadenopathy andileal strictures.

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