Department of Surgery, College of Medicine, Kirkuk University


Background and Aim: Tuberculosis continues to be a common disease in Iraq and one of its presentations is abdominal tuberculosis which tends to present with non-specific features that can be hard to diagnose at times. Histopathological confirmation of abdominal tuberculosis is difficult because of suboptional, noninvasive access to the pathology. The aim of this study was to find out the efficacy of diagnostic laparoscopy in establishing the histopathological diagnosis of abdominal tuberculosis. Patients and Methods: A retrospective study conducted on 67patients with vague abdominal pain, with or without ascites, for whom diagnostic laproscopy was performed in Azadi Teaching Hospital in Kirkuk City over a period of six years (January 2007 - December 2012). Data were collected and statistically analyzed using SPSS software version 16. Results: A total of (67) patients with vague abdominal symptoms and an unsettled diagnosis were included in this study, of which 22(32.8%) of the patients were diagnosed with abdominal tuberculosis on laparoscopy. The common symptoms were abdominal pain, changing bowel habits, loss of weight, fever and generalized weakness. The most consistent laboratory finding (>86%) was a high ESR. Macroscopic findings of abdominal tuberculosis were whitish granulations over both peritoneal layers, inflammatory adhesions on the visceral or parietal surface, thickening, hyperemia and retraction of the greater omentum and stalactic band which is characteristic of abdominal tuberculosis. Direct visualization of the peritoneum and obtaining peritoneal biopsies provided the definitive tissue diagnosis to confirm the clinical diagnosis. Conclusion: Although other diagnostic methods of abdominal tuberculosis such as imaging, culture of ascites and polymerase chain reaction (PCR) are used today, laparoscopy with tissue biopsy provided efficient and reliable diagnostic tool for patients suspected with abdominal tuberculosis. Patients were saved from unnecessary laparotomies and were managed on anti-tuberculosis drug therapy.