Laparoscopy does have a role in tuberculous peritonitis

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7065.1145c (Published 02 November 1996) Cite this as: BMJ 1996;313:1145
  1. J Hossain,
  2. M Kinirons,
  3. R R Lewis
  1. Senior registrar Consultant physician Consultant physician Department of Geriatric and General Medicine, Guy's Hospital, London SE1 9RT

    EDITOR,—We question a statement made in the discussion of the Grand Round on tuberculous peritonitis.1 H J F Hodgson states that, “other things being equal, a trial of antituberculous treatment [rather than laparoscopy] is justified”; this comment is based on anecdotal experience of one patient who died when laparoscopy led to a laparotomy. The stated reason for Hodgson's concern is that “If one has multiple matted pieces of bowel, the process of performing a peritoneal biopsy at laparoscopy is itself hazardous.”

    In a report by one of us (JH) 22 patients who had tuberculous peritonitis underwent laparoscopy and peritoneal biopsy; there were no deaths and few complications.2 In a review Marshall commented on four reports on a total of 110 patients who underwent laparoscopy for peritoneal tuberculosis, with no deaths.3 The procedure is not, however, without risk, and occasional deaths have been reported,4 5 although these seem usually to have been associated with complicating factors.

    Laparoscopy with local anaesthesia enables targeted tissue biopsy specimens to be obtained from the peritoneum, thus allowing a rapid diagnosis, while other conditions, such as peritoneal lymphoma and carcinomatosis, are excluded. Laparotomy, which is associated with a mortality of 3–12% in patients with tuberculous peritonitis,4 may also be avoided. If multiple pieces of matted bowel are found during the procedure and are of concern to the operator then a biopsy specimen need not be obtained, although even then the procedure may provide useful information.4 Because of the advantages of laparoscopy, we believe that Hodgson's view is overcautious and that, if there are no contraindications, the investigation should be considered early in management.


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