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J R Soc Med. 2004 March; 97(3): 155.
PMCID: PMC1079339

Diagnosis of abdominal tuberculosis

We agree with the argument presented by Mr Rai and Mr Thomas (December 2003 JRSM1) for earlier use of diagnostic laparoscopy in suspected abdominal tuberculosis (TB). However, even in the hands of experienced operators the risk is not negligible (though under 1%). The complications, apart from those of general anaesthesia, include damage to blood vessels, bowel and bladder. In Rai and Thomas's series, seemingly, a polymerase chain reaction (PCR) test was not used on the 11 ascitic fluids when acid-fast bacilli were not found. A positive result might have avoided the need for laparoscopy;2,3 furthermore, PCR can help to distinguish Mycobacterium tuberculosis from M. avium in immunocompromised patients.3

In addition, although in 9 of 28 patients ultrasound showed evidence of TB, it seems that fine needle aspiration was not attempted in those with lymph node abnormalities, or colonoscopy in those with an ileocaecal mass. An ultrasound-guided biopsy4 or colonoscopy5 is indicated in the presence of lymphadenopathy, abscess or a focal lesion in the viscera. Finally, Rai and Thomas refer to low haemoglobin and raised C-reactive protein as a consistent feature but say nothing about Ca-125, which can be high in abdominal tuberculosis.6

In our opinion, diagnostic laparoscopy should be used only when less invasive investigations yield no positive results.

References

1. Rai S, Thomas WM. Diagnosis of abdominal tuberculosis: the importance of laparoscopy. J R Soc Med 2003;96: 586–8 [PMC free article] [PubMed]
2. Balian A, de Pinieux I, Bellonla D, et al. Abdominal tuberculosis: deceptive and still encountered. Presse Méd 2000;29: 994–6 [PubMed]
3. Bouma BJ, Tytgat KMAJ, Schipper HG, Kager PA. Be aware of abdominal tuberculosis. Neth J Med 1997;51: 119–22 [PubMed]
4. Malik A, Saxena NC. Ultrasound in abdominal tuberculosis. Abdom Imaging 2003;28: 574–9 [PubMed]
5. Ibrarullah M, Mohan A, Sarkari A, Srinivas M, Mishra A, Sundar TS. Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy. Trop Gastroenterol 2003;23: 150–3 [PubMed]
6. Thakur V, Mukherjee U, Kumar K. Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis. Med Oncol 2001;18: 89–91 [PubMed]
2004 March; 97(3): 155.

Authors' reply

We agree that simple diagnostic tests should be tried first, though commonly unhelpful. All 25 patients in our series who underwent diagnostic laparoscopy had shown inconclusive Mantoux and ascitic fluid staining results. We have no experience with use of the PCR test on ascitic fluid in patients suspected of abdominal tuberculosis.


Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press