Diagnostic Accuracy of Laparoscopy in Abdominal Tuberculosis

Abstract

Background: Abdominal tuberculosis is a most common type of extra-pulmonary tuberculosis. Ileocecal area is the most commonly involved site due to the abundance of lymphoid tissue (Peyer’s patches). Abdominal tuberculosis can mimic a variety of other abdominal conditions and only a high degree of suspicion can help in the diagnosis otherwise it is likely to be missed or delayed resulting in high morbidity and mortality. Objective: The objective of study was to determine the diagnostic accuracy of laparoscopy for the diagnosis of abdominal tuberculosis taking histopathology as gold standard. Study Design: Cross-sectional Study. Settings: Department of General Surgery, Nishtar Hospital, Multan Pakistan. Duration: 1^st April 2021 to 30^th September 2021. Methods: A total of 230 patients of either gender presenting with clinically suspected abdominal tuberculosis were included. Patients having history of decompensated cardiopulmonary failure, acute MI, bacterial peritonitis, coagulopathy and huge ventral hernia were excluded. General anesthesia was given to all patients undergoing laparoscopy. To introduce first trocar in the sub umbilical area which was of 10mm, open method was used so that injury to the gut can be avoided as there are chances of gut adhesions to the anterior abdominal wall in case of abdominal tuberculosis. Second trocar was introduced in the mid clavicular line in the right sub costal region under direct vision. Second trocar was of 5mm size. 3 or 4 peritoneal biopsies, omental biopsies, tubercles, lymph nodes were taken by biopsy forceps from multiple areas, biopsies were properly labeled and sent to pathology department for histopathology. Non absorbable sutures were used for closure of trocar sites. The diagnosis on diagnostic laparoscopy were made and data collected. Results: Ranges of the ages in this study were from 25 to 40 years with mean age of 33.521±3.55 years, while mean BMI was 26.756±1.80 Kg/m² and mean duration of symptoms was 6.960±1.55 months. Majority of patients were males i.e.,66.1%. Laparoscopy had diagnosed 22.6% and gold standard histopathology has diagnosed 21.3% patients with abdominal tuberculosis. Laparoscopy had shown sensitivity of 87.8%, specificity 95%, diagnostic accuracy by 93%, PPV 82.6% and NPV by 96.6% in diagnosis of abdominal tuberculosis. Conclusion: Diagnostic laparoscopy should be used for the prompt diagnosis and timely management of the abdominal tuberculosis as visual appearance of the abdominal tuberculosis is highly suggestive of the disease. This visual appearance must always be supported by the histopathological examination if the biopsies. If we only consider histological examination in diagnosis of abdominal tuberculosis it frequently delays the treatment.