Role of diagnostic laparoscopy in undiagnosed abdominal tuberculosis

Background: Abdominal tuberculosis (TB) remains a significant diagnostic challenge due to its nonspecific presentation and the limited sensitivity and specificity of conventional diagnostic modalities such as ultrasonography (USG) and contrast-enhanced computed tomography (CECT). Diagnostic laparoscopy offers direct visualization of intra-abdominal pathology and enables targeted biopsies, thereby enhancing diagnostic accuracy. Aims and Objectives: The aims and objectives of this study are to evaluate the diagnostic efficacy of laparoscopy in patients with suspected abdominal TB by assessing its gross intra-abdominal findings, comparing its sensitivity and specificity with USG and CECT, and determining its utility in obtaining appropriate tissue samples for histopathological and microbiological confirmation. Materials and Methods: A prospective observational study was conducted on 50 patients with clinical suspicion of abdominal TB at Maharani Laxmi Bai Medical College, Jhansi, from January 2023 to June 2024. All patients underwent clinical assessment, imaging (USG and CECT), diagnostic laparoscopy, and biopsy. Ascitic fluid was analyzed for cytology, biochemistry, and cartridge-based nucleic acid amplification test (CBNAAT). Histopathology was used as the diagnostic gold standard. Data were statistically analyzed using the Statistical Package for the Social Sciences v26.0. Results: Laparoscopy demonstrated 100% sensitivity in diagnosing abdominal TB, with characteristic findings such as tubercles and omental deposits showing strong correlation with histopathology (P=0.01). CECT showed higher diagnostic accuracy (sensitivity 81.81%, specificity 76.40%) compared to USG (sensitivity 72.73%, specificity 11.76%). CBNAAT of ascitic fluid achieved 100% sensitivity and specificity. Conclusion: Diagnostic laparoscopy is a highly sensitive and safe modality for evaluating suspected abdominal TB and should be integrated into the standard diagnostic protocol for patients with unclear abdominal pathology.