Pitfalls of diagnostic laparoscopy in abdominal tuberculosis.
BACKGROUND
Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium for abdominal tuberculosis (TB). However, the laparoscopic view may be deceiving even to the most experienced eyes, and it is not uncommon for TB to be diagnosed erroneously before the final histologic confirmation is received.


METHODS
A retrospective review of 20 diagnostic laparoscopies was conducted. The cases erroneously diagnosed at laparoscopy were collected and analyzed.


RESULTS
Five cases (20%) were identified. For two patients, the laparoscopic findings were thought to be those of carcinomatosis, but histology showed TB. For the other three patients, TB was suspected laparoscopically, but the final diagnoses were carcinomatosis, spontaneous bacterial peritonitis, and panniculitis. Two patients died: one due to delayed diagnosis and treatment of abdominal TB and the other due to carcinomatosis.


CONCLUSIONS
For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.
Meshikhes
Abdul-Wahed Nasir
AW
Department of Surgery, King Fahad Specialist Hospital, Dammam 31444, Eastern Province, Saudi Arabia. meshikhes@gmail.com
D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D003952:Diagnostic Imaging; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis*; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis*