Abdominal tuberculosis can be difficult to diagnose. In order to minimize diagnostic delay, an audit study showed that the Mantoux test and/or culture of ascitic fluid did not reveal tuberculosis immediately. Laparoscopy/laparotomy with Ziel-Nielson staining and culture of tissue biopsy always confirmed the diagnosis. It is suggested that biopsy should be the first line in investigating patients suspected of having abdominal tuberculosis.