Volume : VII, Issue : I, January - 2018

Computerised Tomography versus Diagnostic Laparoscopy in Diagnosis of Abdominal Tuberculosis

Tariq A Mir, Muneer A Wani, Mir Nadeem, Ajaz N Koul

Abstract :

 

Background: Abdominal tuberculosis presents with vague symptoms and marked by a delay in establishing a diagnosis. Present study was done to compare the utility of Computerised Tomography abdomen with diagnostic laparoscopy in the diagnostic algorithm of Abdominal Tuberculosis.

Method: This study enrolled 25 patients who underwent a preoperative Computerised Tomography followed by an operative procedure in the form of a diagnostic laparoscopy or explorative laparotomy. In these patients findings observed on the preoperative Computerised Tomography were compared with intra–operative findings and tabulated.

Results: The commonest findings on Computerised Tomography were ascitis (72.7%), mesenteric lymphadenopathy (40.9%), omental thickening (36.4%) and retroperitoneal lymphadenopathy (13.4%).Other findings observed on Computerised Tomography abdomen were omental thickening, bowel wall thickening, omental stranding, loculated ascitis, tubo–ovarian mass and matted gut.

In the patients who underwent diagnostic laparoscopy/laparotomy the commonest findings observed was presence of tubercles over peritoneal surface. Tubercles over gut and peritoneum were present in 72% and on omentum in 32%. Other common findings were adhesions (56%),  ascitis (52%), cocoon abdomen was present in 28%.  Other findings were omental thickening, visceral and parietal peritoneum thickening, loculated collection, ileo–caecal mass, gall–bladder mass, mesenteric lymphadenopathy and ileal strictures.

Discussion: Computerised Tomography was found to have a better sensitivity for omental thickening, retro peritoneal lymphadenopathy, bowel wall thickening, omental stranding and mesenteric thickening. Diagnostic laparoscopy had a better sensitivity for tubercles, particularly those less than 5mm, adhesions, matting of gut (cocoon abdomen) and ileal strictures. These two diagnostic modalities had nearly equal sensitivity towards findings like collection, loculated or generalised and peritoneal thickening.  Moreover, the retrieval of tissue for histopathological examination is possible only with laparoscopy/laparotomy, making it a more accurate diagnostic investigation.

Conclusion: Computerised Tomography has a better sensitivity for omental thickening, retro peritoneal lymphadenopathy, bowel wall thickening, omental stranding and mesenteric thickening. Diagnostic laparoscopy was found to have better sensitivity for detection of tubercles, particularly those less than 5mm, adhesions, matting of gut (cocoon abdomen) and ileal strictures while these findings were easily picked up on laparoscopy. Both these diagnostic modalities had nearly equal sensitivity towards findings like intra–abdominal collection, loculated or generalised and peritoneal thickening.

Keywords :

Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Tariq A Mir, Muneer A Wani, Mir Nadeem, Ajaz N Koul, Computerised Tomography versus Diagnostic Laparoscopy in Diagnosis of Abdominal Tuberculosis, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-7 | Issue-1 | January-2018

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