JRSM > Volume 97, Number 3 > Pp. 155

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Diagnosis of abdominal tuberculosis

Michelle Petrou   Vassilis Vassiliou¹

University College London Medical School
¹ Department of Medicine, Box 31, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK

E-mail:vassiliou{at}doctors.org.uk

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 Med2003; 96:586 –8[Abstract/Free Full Text]

2. Balian A, de Pinieux I, Bellonla D, et al. Abdominal tuberculosis: deceptive and still encountered. Presse Méd 2000;29:994 –6

3. Bouma BJ, Tytgat KMAJ, Schipper HG, Kager PA. Be aware of abdominal tuberculosis. Neth J Med1997; 51:119 –22[Medline]

4. Malik A, Saxena NC. Ultrasound in abdominal tuberculosis. Abdom Imaging2003; 28:574 –9[Medline]

5. Ibrarullah M, Mohan A, Sarkari A, Srinivas M, Mishra A, Sundar TS. Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy. Trop Gastroenterol2003; 23:150 –3

6. Thakur V, Mukherjee U, Kumar K. Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis. Med Oncol2001; 18:89 –91

Authors' reply

S Rai   W M Thomas

Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, UK

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.

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Petrou, M. Articles by Thomas, W M Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?