Genital Tuberculosis

All of These

Mycobacterium can be grown from menstrual blood; Associated with infertility; and Ectopic pregnancy is common Most common symptom of TB is infertility. It is seen in 35 – 60% of cases.

Cause of infertility : Blockage of the fallopian tube or Altered tubal and Endometrial function in presence of patent tubes.

• Ectopic pregnancy : Every woman who had or has, a tubal pregnancy should be suspected of having tubal tuberculosis active or healed.
• Dysmenorrhea : Shaw does not specify whether dysmenorrhea is common or uncommon in TB. “Dysmenorrhea rarely, if occurs.”
• For diagnosis : Dilatation and curettage is done in the premenstrual phase and specimen sent for histo pathological examination and culture.

First day menstrual blood can also be used but the ^results are not as ^satisfactory as premenstrual tissue. °

It For more details about Genital ^Tuberculosis, see previous answer

Fallopian tube

Ans. is a and b i.e. Laparoscopy and Observation                                                             

• Perforation of the uterus occurs in 0.63% of D and C’s done.
• Perforation should be suspected when the sound / curette meets no resistance at the point expected. Management
• Curettage can be continued if the area of suspicion can be avoided.
• In case suction curettage is being done and is associated with perforation : Laparoscopy must be used to continue the procedure to avoid aspiration of bowel into the uterine cavity.
• Unless there is evidence of haemorrhage injury to bowel or evulsion of omentum -conservative treatment of uterine perforation is the best                                                                                                                
• In hemodynamically stable patients, laparoscopy is the method of choice for evaluating perforation size and site.
• The patient should be observed for atleast 24 hours in the hospital for possible infection or hemorrhage.
• Most of the patients require only expectant treatment. Only in those who bleed internally laparotomy may be required.

Endosalpingitis

Fallopian tubes

Sterility is common presenting symptoms

Fallopian tube

Ectopic pregnancy

Ans. is d i.e. Mycobacterium tuberculosis                                   

The following findings on hysterosalpingogram strongly suggest tubercular salpingitis :

1. A rigid nonperistaltic pipe like tube. called lead pipe appearance°
2. Beading and variation in filling density°
3. Calcification of the tube°
4. Cornual block°
5. A jagged fluffiness of the tuba! outline°
6. Vascular or lymphatic intravasation of the dye°
7. Tobacco – pouch seen at naked eye examination.

Also Note : • In a proven case of genital tuberculosis, hysterosalpingography is contraindicated as it may spread the infection.

• In TB Endometritis on HSG : the uterine cavity is shrivelled and obliterated by adhesions.
• On USG : Incomplete septation of the tubal wall “Cogwheel sign” is a marker for acute disease. Thin wall and beaded string appearance is a marker for chronic disease.

Hematogenous route REF: Shaw’s Gynecology 13th ed p. 147

“Most common route of spread of genital tuberculosis is through blood stream”

Fallopian tubes REF: Shaw 14^th edition p. 139

“Most common site od genital tuberculosis id fallopian tube”

Genital Tuberculosis:

• Secondary to focus anywhere else
• Most common route of spread- Hematogenous
• Most common route of transmission to endometrium – retrograde spread
• Most common site – fallopian tube
• Most common symptom- infertility

‘Bead-like’ fallopian tube and clubbing of ampulla in a case of infertility indicates previous infection with Mycobaterium tuberculosis.

Ref: Shaw’s Textbook of Gynaecology, 12th Edition, Page 119 ; Textbook of Gynecology By D C Dutta, 4th Edition, Page 132

‘Bead-like’ fallopian tube and clubbing of ampulla in a case of infertility indicates previous infection with Mycobaterium tuberculosis.

Ref: Shaw’s Textbook of Gynaecology, 12th Edition, Page 119 ; Textbook of Gynecology By D C Dutta, 4th Edition, Page 132

Genitourinary TB includes renal, ureteral, bladder, uterine-fallopian, prostatic, and epididymal disease. It is slightly more common in women than men and tends to involve older populations. 

Genitourinary tuberculosis is commonly secondary to infection elsewhere in the body, usually pulmonary, but active pulmonary disease can be documented in only one-third of patients.

Vascular dissemination is responsible for infection of the fallopian tubes in almost all patients with genital tuberculosis, and involvement of the endometrium follows in 90%.

Cervical disease can occur by direct extension or lymphatic spread, occurring in only 1% of cases. 

‘Bead-like’ fallopian tube and clubbing of ampulla in a case of infertility indicates previous infection with Mycobaterium tuberculosis. Ref: Shaw’s Textbook of Gynaecology, 12th Edition, Page 119 ; Textbook of Gynecology By D C Dutta, 4th Edition, Page 132

Ans. B i.e. Fallopian tubes