A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis.
BACKGROUND
The incidence of abdominal tuberculosis is much higher in an HIV-positive cohort. The use of laparoscopy in the diagnostic work-up of suspected abdominal tuberculosis is underutilized and its use and efficacy in the context of HIV co-infection has never been examined.


METHODS
A prospective clinical audit of the use of diagnostic laparoscopy was conducted in patients with clinically suspected abdominal tuberculosis but histologically or microbiologically unconfirmed tuberculosis at any site.


RESULTS
From January 2008 to June 2010, 81 patients underwent diagnostic laparoscopy; 34 were male and 47 were female, with a mean age of 33 years, and 77 % were HIV-positive. Fifty-five patients (68 %) had positive histology or culture for tuberculosis. In 15 patients (19 %), histology revealed non-specific inflammation, no pathology was found in one patient, and no specimen was taken from one patient. Eighty percent of peritoneal deposits and 77 % of lymph nodes were positive for tuberculosis, whereas 35 % of ascitic fluid cultures were positive. In nine patients (11 %) an alternative diagnosis was found; nine patients (11 %) had conversion to laparotomy. There was no procedure-related death. Nine patients (11 %) died during the 2-month follow-up period.


CONCLUSIONS
Diagnostic laparoscopy avoids the morbidity and mortality of laparotomy in chronically ill patients, and reduces the rate of misdiagnosis of other abdominal conditions and unnecessary long-term therapy. Diagnostic laparoscopy and tissue sampling is a viable and reliable strategy in patients with suspected abdominal tuberculosis.
Department of Surgery, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa, islam@telkomsa.net.
J
J
Islam
D
D
Clarke
S R
SR
Thomson
D
D
Wilson
H
H
Dawood
D000328:Adult; D060085:Coinfection / Q000175:diagnosis*; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008485:Medical Audit; D014395:Peritonitis, Tuberculous / Q000175:diagnosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis* / Q000473:pathology