Purpose: With the effectiveness of antituberculous chemotherapy, the clinical outcome of tuberculous peritonitis depends much on the diagnostic accuracy and timing. This study was done to evaluate the diagnostic efficiency of laparoscopy and to make algorithm for tuberculous peritonitis.
Methods: We reviewed the medical records of 28 patients who were suspected tuberculous peritonitis clinically and radiologically and performed laparoscopy for diagnosis between January 1996 and July 2003.
Results: The ratio of male to female was 1：1.3. the mean age was 49 years. The most common symptom and sign were abdominal pain (96%) and ascites (64%). Ascitic analysis in mean value were revealed 4.79 g/dL in protein, 2.2 g/dL in albumin, 96 mg./.dL in glucose, 83% in lymphocyte, 610 U/L in LDH and 86 U/L in ADA. AFB stains of ascites were all negative. On chest X-ray, pulmonary tuberculosis or associated lesions were noted in 9 cases (32%). Laparoscopic findings were revealed multiple nodules (100%), ascites (89%) and adhesion (43%). Histologic results were revealed caseous granuloma in 25 patients (89%), adenocarcinoma in 2 patients (7%) and chronic inflammation in 1 patient (4%). The patient with chronic inflammation was highly suspected tuberculous peritonitis in laparoscopic finding. So therapeutic trial with antituberculous medication was started and tuberculous peritonitis was confirmed later by clinical improvement. There was no surgical complication.
Conclusion: Laparoscopy is a safe, rapid and accurate modality for the definite diagnosis in tuberculous peritonitis. And we recommand therapeutic trial for 2 months in the patients highly suspected tuberculous peritonitis in cases of failed pathologic diagnosis in laparoscopic biopsy.
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