A diagnostic approach to abdominal tuberculosis

Abstract

Key Words: Abdominal tuberculosis

TO THE EDITOR

We read with interest the article by Uzunkoy et al[1]. about diagnosis of abdominal tuberculosis. In this article authors concluded that PCR for mycobacterium tuberculosis complex is a noninvasive method which can provide the diagnosis in most cases. If this tests negative or not feasible, laparotomy should be performed.

Previously, we analyzed and reported the diagnostic approach to peritoneal tuberculosis of our clinic[2]. In this paper, diagnosis of the peritoneal tuberculosis was made by image-guided percutanous biopsy (IGPB) in 18/19 of patients. Laparoscopic biopsy was needed only 1/19 patient. Laparoscopic biopsy allows better inspection as well as directed biopsies from peritoneum. However, it requires hospitalization, and has some complications. Therefore, IGPB seems to be an effective, safe and inexpensive method to provide diagnosis of peritoneal tuberculosis. In editorial of this article, Dhiman stated that IGPB is less invasive as compared to laparoscopy, does not requires general anesthesia and can be performed even at bedside. An algorithmic approach was suggested by doing IGPB or image-guided biopsy from associated lessions first, and if the results are inconclusive then laparoscopic biopsy may be the next step[3].

In conclusion, mycobacterial culture requires 8 wk to make diagnosis this delay can give way to an increased mortality rate. If PCR for mycobacterium tuberculosis is not diagnostic or not feasible, IGPB should be performed.