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ORIGINAL ARTICLE
Role of Laparoscopy in Diagnosis of Abdominal Tuberculosis

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Sarfaraj Pathan , Smita V Kakade , Sachin Ambre 3
AbstrAct
Introduction: To study the efficacy of visual impression of the peritoneal cavity by laparoscopy in the diagnosis of abdominal tuberculosis (TB).
Materials and methods: Fifty patients with suspected abdominal Kochs underwent diagnostic laparoscopy, and the visual impression was
compared with other tests like acid-fast bacillus (AFB) stain, AFB culture, histopathology, TB PCR and Gene Xpert.
Observations: Out of 50 patients, 42 (84%) had positive visual findings on laparoscopy characterized by enlarged lymphadenopathy, ascites,
peritoneal tubercles, and interbowel adhesions. Thirty-eight (76%) patients had positive histopathological findings and TB PCR, while thirty-nine
(78%) patients had positive Gene Xpert. So, laparoscopic visualization of abdominal cavity is 100% sensitive for the diagnosis of abdominal
tuberculosis.
Conclusion: Laparoscopy is a safe and rapid method for the diagnosis of abdominal TB.
Keywords: Abdominal tuberculosis, Laparoscopy, Visual impression.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1459

IntroductIon 1–3 Department of Surgery, BJ Government Medical College, Pune,
Tuberculosis (TB) has an incidence of 211 cases per 100,000 population Maharashtra, India
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and adds about 2.8 million cases to the total pool every year. Abdominal Corresponding Author: Sarfaraj Pathan, Department of Surgery,
TB is a major contributor to extrapulmonary TB both incidence BJ Government Medical College, Pune, Maharashtra, India, e-mail:
wise and mortality wise. It accounts for 11–16% of cases of TB. 2–4 It spathan.1978@gmail.com
presents a clinical dilemma due to its myriad ways of presentation. How to cite this article: Pathan S, Kakade SV, Ambre S. Role of
A battery of investigations like erythrocyte sedimentation rate Laparoscopy in Diagnosis of Abdominal Tuberculosis. World J Lap Surg
(ESR), ultrasonography (USG), computed tomography, ZiehlNeelsen 2021;14(3):145–148.
staining, acid-fast bacillus (AFB) culture, and biopsy has been used Source of support: Nil
conventionally to diagnose abdominal TB. However, none of these Conflict of interest: None
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are considered the gold standard for the diagnosis of abdominal TB.
Recent advances in molecular and immunological studies like TB PCR
and Gene Xpert assay have improved the rates of detection, but they
are expensive and time-consuming. Previously, the diagnosis and Inclusion Criteria
treatment of abdominal Kochs were based on either blind biopsy • Patients between the age-group of 18–60 years.
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or visual findings on laparotomy. Recently, greater experience and • Symptoms of abdominal TB—abdominal pain, weight loss, night
availability of laparoscopy has made it possible to have a direct sweats, low-grade fever, or evening rise of temperature.
visual impression of the abdominal cavity with the added benefit • Elevated ESR.
of biopsy. Various studies have proven laparoscopy to be a rapid, • Mantoux test positivity.
safe, and most specific procedure for the diagnosis of abdominal • Abdominal USG showing mesenteric lymphadenopathy—more
Kochs. 2,3,7–9 Ours is an attempt to establish the role of laparoscopy than or equal to 1 cm; Small bowel mesenteric thickening—1.5 cm
for the diagnosis of abdominal Kochs. We have compared the visual or more.
findings by laparoscopy with other tests like AFB stain, AFB culture,
TB PCR, Gene Xpert, and histopathology to prove the efficacy of
diagnostic laparoscopy. Procedure
All patients underwent diagnostic laparoscopy under general
AIms And objectIves anesthesia. Ports are placed as shown in Figure 1. A 10 mm, 30°
laparoscope was inserted through the infraumbilical port using
To study the efficacy of visual impression of peritoneal cavity by Hasson’s technique. The peritoneal cavity was systematically
laparoscopy in the diagnosis of abdominal tuberculosis.
examined as follows: Parietal peritoneum, small bowel loops with
mesentery, appendix, large bowel, subdiaphragmatic area, liver,
mAterIAls And methods stomach, pelvis, and the rest of the cavity. Peritoneal-free fluid
Our study included 50 patients who presented with features was collected. The mesentery was traced from ileocecal region
suggestive of abdominal TB. proximally to look for enlarged mesenteric lymph nodes and

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