Annie Immaculate Mary, G J (2021) Evaluation of Diagnostic Laparoscopy in patients with suspected abdominal tuberculosis. Masters thesis, Tirunelveli Medical College, Tirunelveli.
Full text not available from this repository.Abstract
NEED FOR THE STUDY: Tuberculosis continues to be a common disease in our country, and Its one of presentations is abdominal tuberculosis. Histopathological confirmation of abdominal tuberculosis is difficult because of suboptional, noninvasive access to the pathology. Laparoscopy provides minimally invasive access to the peritoneum. OBJECTIVES OF THE STUDY: To Evaluate the role and importance of diagnostic laparoscopy in patients with suspected cases of abdominal tuberculosis. MATERIALS AND METHODS: SOURCE OF THE DATA: Patients with suspected cases of abdominal tuberculosis In the department of General Surgery in Tirunelveli Medical College and Hospital between September 2018 to July 2020. The study will include 30 cases of suspected abdominal tuberculosis. The duration of study is 2 years. METHOD OF COLLETION OF DATA: STUDY DESIGN AND SAMPLING: • This is a prospective randomized study comprising 30 patients with suspected abdominal tuberculosis. • Sample size: 30. INCLUSION CRITERIA: • Abdominal pain of more than three months duration with or without history of fever, distension of abdomen, loss of appetite or loss of weight. • Recurrent episodes of sub-acute intestinal obstruction with or without history of previous pulmonary tuberculosis. • Patients for evaluation ascites with unsetteled diagnosis on imaging studies. EXCLUSION CRITERIA: • Patients presenting with acute intestinal obstruction or evidence of peritonitis on the clinical evaluation. • Patients with chronic pain in the abdomen and diagnosed cases of acute pulmonary tuberculosis already receiving ATT. • Patients with chronic liver disease, cirrhosis, or obvious carcinoma. • If laparoscopy was contraindications. DISCUSSION: It has been established that the incidence of all tuberculosis, including abdominal tuberculosis is rising and the diagnosis is still difficult. The mortality of tuberculous is up to 60% mainly because of delayed or missed diagnosis. To avoid any delay or missed diagnosis we wished to look at the utility of diagnostic laparoscopy in abdominal tuberculosis. Historically peritoneal biopsy or peritoneoscopy used to be done under local anaesthetics with a limited view of the abdominal cavity and higher complication rates, whereas at present laparoscopy is performed under general anaesthesia with better intra-operative views and less complication rates. The male female ratio is highly variable from equal in the series reported by Ramesh et al to marked male predominance reported in Abdelaal A et al and to a marked female predominance in the study of Safarpor Faizollah et al. In present study, disease incidence was found to be more in females 22(73.33%) cases, males were 8(26.67%) The most common symptom in present study was abdominal pain in all 30 patients (100%) followed by vomiting (53.33%), fever (23.33%) and weight loss (20%) and altred bowel habits (6.67%) which is comparable with studies by Rai et al, Khan R et al, Islam J et al. Ultrasonography of abdomen and chest x-ray was non-specific in all patients. In diagnostic laparoscopy 11 (36.67%) patients had various features of abdominal tuberculosis. Mesenteric lymphadenopathy was the one of the common finding in our series and 5 (16.67%) of our patients had lymph nodes biopsied which is comparable with study by Islam J et all. Adhesions were present in 2 patients (6.67%) in our series which was less than in the series by Nafeh et al (42%) and Al-Mulhim et al (52%). Features of recurrent appendicitis was seen in 4 (13.33%) patients. features of chronic cholecystitis, intestinal stricture, ascites, carcinoma ovary, fibrous bands, ovarian cyst are seen in 1 (3.33%) patients. Diagnostic laparoscopy was found to be normal in 2 (6.67%) patients. The most tuberculosis positive histology specimens are tubercles and lymph nodes. The most sensitive and specific specimen is omentum. The least sensitive specimen is peritoneal aspirate. 10 (33.33%) patients had diagnosis other than abdominal tuberculosis for these patients laparoscopic appendectomy for recurrent appendicitis, laparoscopic cholecystectomy for chronic cholecystitis, fibrous band release for fibrous band obstruction, resection anastamosis for stricture and laparoscopic adhesiolysis for adhsions were done, and post operative period was uneventful. Histopathological examination showed 18 (60%) patients had features of tuberculosis and 18 (60%) patients were treated with ATT. CONCLUSION: The diagnostic laparoscopy in suspected cases of abdominal tuberculosis is an efficient and rewarding method of diagnosis. A regular use of this diagnostic modality can improve the overall outlook of this common disease in the developing world. Laparoscopy has an effective diagnostic role in evaluating patients with Vague abdominal symptoms in whom conventional methods of investigations have failed to elicit a certain cause. The therapeutic value of diagnostic laparoscopy is also accepted, well appreciated and it cannot be underestimated. Being minimally invasive laparoscopy has solved the problem of delay in the definitive diagnosis and had led to considerable reduction in the number of negative laparotomies. It has also significantly reduced the number of investigations and days of hospital stay which leads to substantial reduction in the cost of treatment.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221811352 |
| Uncontrolled Keywords: | Diagnostic Laparoscopy, patients, suspected abdominal tuberculosis. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 24 Apr 2021 04:25 |
| Last Modified: | 10 Nov 2021 23:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15018 |
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