Role of laparoscopy in diagnosis of peritoneal tuberculosis (About 414 cases)

Peritoneal tuberculosis is still common in Morocco. Its diagnosis is based on several methods. Laparoscopy with directed biopsies is still considered as the referenced method. The aim of our work is to show the place and the importance of laparoscopy in the diagnosis of peritoneal tuberculosis through the study of various endoscopic aspects. Materials and Methods: This is a retrospective descriptive study extended from January 2001 to December 2011. We collected 414 cases of isolated ascites confirmed by ultrasonography. Different parameters were analyzed: epidemiological data, indications of laparoscopy and its results and complications. Results: The average age of our patients was 38 years (range: 8 years - 90 years) with a female predominance (sex ratio F/M: 2.3). Abdominal ultrasound performed in all patients has confirmed the presence of ascites in 100% of cases. Based on clinical data (soft or tense abdomen) and ultrasound (free or partitioned ascites), we performed a standard laparoscopy in 313 cases and open laparoscopy in 101 cases. The presence of granules was noted in 318 cases (76.8%). Peritoneal tuberculosis was found in 81.5% of cases with small whitish granulations distributed homogeneously, while peritoneal carcinomatosis was confirmed in 86.8% of patients with large granules distributed inhomogeneously. The presence of adhesions was observed in 33% of cases with peritoneal tuberculosis, while it was mentioned in only 2.8 cases of carcinomatosis. Conclusion: Despite the development of imaging means, ascitic fluid culture and PCR (polymerase chain reaction), laparoscopy remains indispensable for an early diagnosis of peritoneal tuberculosis and adequate management.