Evaluation of Diagnostic Laparoscopy Versus Non Invasive Tests in a Suspected Case of Abdominal Tuberculosis

Rajdeep Singh, MS, Anmol Chugh, MS, Prem N Agarwal, MS, Anjali Prakash, MD. Maulana Azad Medical College

INTRODUCTION- Patients with suspected abdominal tuberculosis undergo numerous diagnostic tests because of lack of specific clinical features and difficulty in isolating Mycobacterium tuberculosis. This study was intended to evaluate the role of diagnostic laparoscopy and histopathology in comparison to non-invasive tests in a patient with suspected abdominal tuberculosis.

METHODS AND PROCEDURES- In our prospective study, we evaluated patients suspected of abdominal tuberculosis on the basis of abdominal pain of duration longer than three months. Twenty patients were included from November 2012 to November 2013 and investigated with non-invasive tests like Contrast Enhanced Computed Tomography (CECT) scan abdomen, erythrocyte sedimentation rate (ESR) and Mantoux test. Subsequently, all patients underwent diagnostic laparoscopy and histopathological specimen was collected wherever possible. Histopathology was taken as gold standard.

RESULTS- On laparoscopy, twelve patients were visually diagnosed with tuberculosis which was further confirmed on histopathology. In terms of accuracy and predictive value, visual diagnosis on laparoscopy was found to be most effective (100%). CECT had a lower predictive value (80%) and accuracy (70%) but it was not significant in comparison with results of laparoscopy. ADA levels was not evaluated in our study because of a small sample size, but 1 out of total 4 patients with ascitic fluid it was found to be raised (50 U/L). ESR and Mantoux test had low accuracy, 50% and 65 % respectively in comparison to laparoscopy.

CONCLUSION- Laparoscopy combined with biopsy is the most sensitive and a quick method for diagnosing abdominal tuberculosis. Although in this study there were no complications, laparoscopy being an invasive technique has systemic as well as surgical complications. We found non-invasive tests like CECT abdomen to be an effective method for diagnosing abdominal tuberculosis and hence starting Anti Tubercular Treatment (ATT) on the basis of CECT report can be considered.

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