Diagnostic yield and endoscopic patterns of laparoscopy in the diagnosis of granulomatous hepatitis

In reviewing 54 cases of granulomatous hepatitis (GH) diagnosed among 2,620 laparoscopies, we have been able to classify the capsular GH changes into five patterns: Macular, exudative, pinpoint, granular and cord-like. The exudative pattern was the most frequent one, and predominated in brucellosis. The granular pattern was most common in tuberculosis. Furthermore, 35 additional cases, in whom a laparoscopic diagnosis of GH was not confirmed by liver biopsy, showed a trend to a final diagnosis consistent with multifocal diseases, whenever laparoscopic pictures were similar to the patterns described herein. We speculate with the limits associated with the use of only a single biopsy sample. We conclude that laparoscopy permits the establishment of a tentative diagnosis of GH, which could provide us with valuable information about the usefulness of obtaining multiple hepatic biopsies.