Peran Laparoskopi dalam Mendiagnosis Asites akibat Etiologi yang tidak Diketahui

Objective: To determine the evidence about timing and role of laparoscopy in ascites work-up. Methods: : Case report Case: A-26-year-old P2 woman went to our hospital with a history of vaginal delivery 22 days before admission. She also presented with massive ascites. No obstetric complication was found. Transvaginal ultrasound revealed normal postpartum uterus and ovaries, surrounded with ascites. Both the liver and kidneys were found normal on ultrasound. Abdominal CT scan with contrast showed massive ascites with thickened omentum. Ascites ADA (adenosine deaminase) was 36 IU/L. Diagnostic laparoscopy was performed, we found massive yellowish ascites, miliary whitish lesions and hyperaemic tubal enlargement with thickening of the peritoneum. Biopsy was taken, pathology examination showed the appearance of chronic salpingitis and granulomatous peritonitis, in accordance with tuberculosis peritonitis. Conclusions: Laparoscopy should be the method of choice in diagnosing ascites with unknown etiology after inconclusive results of laboratory and radiological examination. Better visualization, typical appearance in peritoneal TB, chance to perform direct biopsy with lower risk of morbidity are the hallmarks of laparoscopy to be the method of choice to rule out the etiology of ascites.