Genital Tuberculosis

FEATURES:

• Primary focus in lungs-50%
• Fallopian tube is the most frequently involved part (100%).followed by uterus (70-80%), ovaries (30%)
• The lesions are often bilateral.
• Blood stream is the commonest method of spread
• Initial site- submucosal layer of ampulla.

SYMPTOMS:

• Infertility

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.
• Commonest menstrual disturbance: Menorrhagia

DIAGNOSIS:

• Mycobacterium can be grown from menstrual blood in TB patient showing pelvic inflammation
• The commonest type of genital tuberculosis is Endosalpingitis

The following findings on hysterosalpingogramstrongly suggest tubercular salpingitis:

• A rigid nonperistaltic pipe like fallopian tube called lead pipe appearance
• Beading and variation in filling density
• Clubbing of ampula
• Calcification of the tube
• Cornual block
• A jagged fluffiness of the tubal outline
• Vascular or lymphatic intravasation of the dye
• Tobacco – pouch seen at naked eye examination.

Endometrial Biopsy:

• Perforation can occur
• Sound / curette meets no resistance at the point expected. 

Management

• In hemodynamically stable patients, laparoscopy is the method of choice for evaluating perforation size and site.
• Most of the patients require only expectant treatment. Only in those who bleed internally laparotomy may be required.