A Study on the Efficacy of an Open Peritoneal Biopsy for Abdominal Tuberculosis in a Tertiary Medical Centre: Analysis of 69 Cases 987-989
Dr. Sujit Kumar Bhattacharyya
Vill-Aminpur, P.O., Khamarchandi
P.S-Haripal, Hooghly (DISTRICT),
West Bengal, India - 712405.
Background: The diagnosis of abdominal tuberculosis is often empirical, based on indirect evidences. A polymorphous clinical presentation, non-specific biological markers, a minimally contributive bacteriology and non-specific radiographic signs raise diagnostic difficulties in abdominal tuberculosis. A peritoneal biopsy may be useful in confirming the diagnosis of abdominal tuberculosis.
Aims: In this study, we evaluated the efficacy of an open peritoneal biopsy for the confirmation of abdominal tuberculosis.
Methods and Materials: We selected 69 cases of suspected abdominal tuberculosis. Among them, 28 cases were diagnosed by Ultrasound (USG) guided Fine Needle Aspiration Cytology (FNAC) from the abdominal lymph nodes or lumps and 38 cases were diagnosed by the examination of the lymphocytic exudative ascitic fluid with a high adenosine deaminase content. 3 cases could not be diagnosed by either means. All the 69 cases were subjected to open peritoneal biopsies.
Results: Abdominal pain and tenderness were the presenting clinical features in all the cases. The histopathological examination of the open peritoneal biopsy material confirmed the diagnosis by revealing caseating granulomas in 33 (47.83%) cases. These included 2 cases among 3 which could not be diagnosed by FNAC of the abdominal lymph node or by ascitic fluid examination. Mycobacterial cultures which were done from the biopsy materials were positive in 18(26.08%) cases and all of them had caseating granulomas. The peritoneal biopsies were confirmatory in 19 out of the 38(50%) cases with ascites and in 14 out of the 31(45.16%) cases without ascites. One case could not be diagnosed by either of these three means. She was put on empirical anti tuberculour drugs to which she responded.
Conclusion: The classical biological and radiological investigations are not specific and their contributions remain little in the diagnosis of abdominal tuberculosis. Open peritoneal biopsies are safe and helpful in confirming abdominal tuberculosis, particularly in the ascitic cases and the mycobacterial cultures did not improve the diagnostic yield over the histopathological examination of the biopsy materials.