➢
Etiology
• Mycobacterium tuberculosis ( human bacillus ) > Mycobacterium bovis
• Becoming more common nowadays 5% infiertility cases
➢
Route of infection
• Blood borne ( from 1
ry
pulmonary TB ) most common
• Peritoneal spread ( TB peritonitis )
• Lymphatic spread ( TB of mesenteric LNs )
• Ascending with infected semen ( TB epididymitis )
➢
Pathology
Tubes ( 100 % ) adhesive or exudative
• PERISALPINGITIS miliary tubercles + adhesions
• INTERSTITIAL SALPINGITIS thick , nodules , caseous material
• ENDOSALIPINGITIS pyosalpinx full of caseous material
• SALPINGITIS ISTHMICA NODOSA
Uterus ( 50 % ) . Tubercles surrounded by granulomatous tissue
. Caseation , atrophy , Asherman
,
s syndrome
Ovaries ( 25 % ) may appear normal or granulomas , caseation , fibrosis
Cx ,vag , vulva ( 5 % ) Hypertrophic polypi
Ulcers :serpiginous outline , undermined edges , yellow floor , not indurated
➢
Clinical picture
History ( family or exposure or endemic area )
Symptoms
• General TB toxemia ( NNLL ) …………. Chest symptoms of TB
• Abdomen peritoneal TB ………… ascites , sinuses
• Pelvic
▪
Infertility ( due to GC , tubal block , anovulation , endometrial TB )
▪
Pelvic congestion
• Pain ( D
,
s )
• Bleeding
• Discharge
▪
Amenorrhea ( GC , anovulation , endometrial TB , E by TB toxins )
✓
✓
+
-
-
+
Tuberculosis
➢
Signs General / chest
Abdominal
Local . Tubercles ( nodules ) in vulva , vagina , cervix
. Uterus +fixed RVF
. Adenexae +adnexal swelling
. Douglas pouch + nodules
➢
Investigations
General Blood ( TLC , ESR ) , chest X- ray
+
1) Endometrium ( D
&
C biopsy or menstrual shedding by cx cap ) for
Zeil Neilson stain bacilli + excess lymphocytes
Culture on Dorset egg or Lowenstein Jensen medium
Animal inoculation guinea pig ( liver & spleen examined after 40 days )
2) Vulva , vagina , cervix
biopsy from lesions
3) Tubes
HSG .
Sausage shaped , lead pipe , hydrosalpinx , calcification+ patent
. peritubal adhesions ( localized collections of dye )
. intrauterine adhesions , micropoucheintravasations
Endoscopy laparoscopy + biopsy
Tube is sausage shaped , pale with tubercles ,
Calcification , caseation , dense adhesions
➢
Treatment
Medicalantituberculous drugs
2 month Isoniazid ( 5 mg / kg / day ) +
Rifampicin ( 10 mg / kg / day ) +
Ethambutol( 15 mg / kg / day ) or Sterptomycin ( 1 mg 1 M / day )
7 month Rifampicin + Isoniazid
Surgical
• No tubal microsurgery ( v. imp )
• TAH & BSO are only done if large masses are present+ fistula
✓
✓