Endoscopic Findings of Female Genital Tract Tuberculosis: A 3-year Analysis at a Referral Center

Jain, Vandana; Jain, Nutan; Srivastav, Sonil; Agarwal, Kriti

doi:10.5005/jp-journals-10058-0024

Cited by 4 publications

(8 citation statements)

References 105 publications

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“…[ 24 ] Various other studies have also proven the utility of diagnostic laparoscopy alone or in combination with other molecular methods for better and early detection of FGTB. [ 25 26 27 28 29 ]…”

Section: Discussionmentioning

confidence: 99%

Comparative study on complications and difficulties in laparoscopy in female genital tuberculosis cases versus non-tuberculosis cases

Sharma,

Dharmendra,

Rapaka

et al. 2023

Journal of Minimal Access Surgery

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Background and Objective: Female genital tuberculosis (FGTB) is an important type of extrapulmonary tuberculosis (TB) associated with morbidity especially infertility in developing countries. Laparoscopy may be difficult and hazardous in FGTB. The aim of the study was to observe the difficulties and complications of laparoscopy in FGTB cases. Materials and Methods: It was a prospective study over 12 years’ period on 412 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling for acid-fast bacilli (AFB) microscopy, culture, polymerase chain reaction (PCR), gene Xpert (last 212 cases) and histopathological evidence of epithelioid granuloma. Another 412 cases of diagnostic laparoscopy in the absence of FGTB performed during same time were taken as controls from the pool of non-TB cases. Various difficulties and complications were noted in both groups and statistical analysis was done. Results: Mean age, parity, body mass index and duration of infertility were 26.8 versus 25.4 years, 0.32 versus 0.28, 23.15 versus 25.28 Kg/m2 and 4.15 versus 5.12 years, respectively. Primary and secondary infertility was seen in 78.6% and 20.38% of cases in the study group and 74.75% and 25.24% in the control group, respectively. Endometrial biopsy showed AFB microscopy in 5.3%, culture in 6.3%, epithelioid granuloma in 15.77% and on peritoneal biopsy granuloma in 6.55%, positive PCR in 368 (89.32%) and positive gene Xpert in 38 out of 212 (17.92%, out of last 212 cases). Definite findings of FGTB were seen in 171 (41.50%) cases. Probable findings of FGTB were seen in 241 (58.49%) cases. Various complications were difficulty in the creation of pneumoperitoneum or insertion of trocar and cannula in 16.74% and 13.10% of cases as compared to 1.94% and 1.69% in the control group. Excessive bleeding was seen in 5.09% versus 0.97% cases, respectively. Various injuries observed were bowel injury in 1.69% versus 0.24% cases (small bowel in 1.21% vs. 0.24%, large bowel in 0.48% vs. 0.1%), while bladder injury was seen in 0.97% versus 0.24% cases, subacute intestinal obstruction was seen in 5.8% versus 0.72% cases respectively while flare up of TB was seen in 5.09% versus 0% in cases and controls, respectively. Wound infection was seen in 8.48% versus 1.25% cases, respectively. Interpretation and Conclusion: FGTB is associated with increased complications and difficulties as compared to laparoscopy in other cases.

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Section: Discussionmentioning

confidence: 99%

Comparative study on complications and difficulties in laparoscopy in female genital tuberculosis cases versus non-tuberculosis cases

Sharma,

Dharmendra,

Rapaka

et al. 2023

Journal of Minimal Access Surgery

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“…Endoscopy, especially celioscopy or laparoscopy with directed tissue biopsy, is an important diagnostic test with high sensitivity and can detect various TB findings such as tubercles, caseous nodules and probable findings like encysted ascites, pelvic and abdominal adhesions, hydrosalpinx, pyosalpinx, beaded nodules, nodular salpingitis, patchy salpingitis, tubular blockage and obliterated or frozen pelvis. [ 11 12 13 14 15 ] However, laparoscopy is invasive with a potential significant risk of haemorrhage, infection flare up and bowel injury and should be performed by experienced consultants. [ 20 ] The WHO recommends treatment of drug-sensitive EPTB, including abdominopelvic TB and FGTB for 6 months in the same manner as pulmonary TB.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 6 7 8 9 10 ] Endoscopic procedures, especially laparoscopy, reliably facilitate pelvic and abdominal organs visualisation and specimen collection with high sensitivity to pick up abdominopelvic TB. [ 11 12 13 14 15 ] It can detect various TB findings such as tubercles, caseous nodules, adhesions and tubal findings. [ 11 12 13 14 15 ]…”

Section: Introductionmentioning

confidence: 99%

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JB Sharma’s white cotton ball sign: A new laparoscopic sign in abdominopelvic tuberculosis

Sharma

2023

Journal of Minimal Access Surgery

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Background: Abdominopelvic tuberculosis (TB) is a variant of extrapulmonary TB causing significant morbidity, including infertility. Materials and Methods: Results of 87 cases of diagnostic laparoscopy in cases of abdominopelvic TB diagnosed on composite reference standard (CRS) for demonstration of new laparoscopic white cotton ball sign are presented. Results: Mean age, parity and duration of infertility were 27.2 years, 0.21 and 3.1 years, respectively. Oligomenorrhoea and hypomenorrhea were seen in 35 (40.22%) and 32 (36.78%) cases, while infertility was seen in all 87 (100%) cases while abdominal mass was seen in 27 (31.03%) cases and pelvic mass in 37 (42.58%) cases. Positive acid fast bacilli on microscopy and culture of endometrial biopsy was seen in 3.34% and 6.89% cases while epithelioid granuloma was seen in 12.64% cases on endometrial biopsy and in 13.79% cases on peritoneal biopsy. Positive polymerase chain reaction was seen in all cases while definitive abdominal pelvic TB was seen in 35 (40.1%) cases and probable findings in 42 (48.27%) cases. A new laparoscopic white cotton ball sign (resembling a large white cotton ball) was observed in 5 (5.74%) cases and biopsy from 3 showed it to be epithelioid granulomas positive. Conclusion: Demonstration of a new white cotton ball sign on laparoscopy seems to be a useful finding in abdominal pelvic TB.

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“…Endoscopic evidence of tubercles or caseous nodules is often considered diagnostic ( Table 3 ). Other findings consistent with FGTB include pelvic and intrauterine adhesions, beaded or lead-pipe appearance of the fallopian tubes, hydrosalpinx, tubo-ovarian masses, and a distorted or shrunken endometrial cavity [ 69 , 70 ]. In severe cases, extensive internal adhesions cause genital organs to become attached (“frozen pelvis”) [ 27 ].…”

Section: Diagnostic Approachmentioning

confidence: 99%

Female Genital Tuberculosis

Tzelios

Neuhausser

Ryley

et al. 2022

Open Forum Infectious Diseases

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Female genital tuberculosis (FGTB) is an important cause of morbidity and infertility worldwide. Mycobacterium tuberculosis (Mtb) most commonly spreads to the genital tract from a focus elsewhere in the body and affects the bilateral fallopian tubes and/or endometrium. Many patients with FGTB have indolent disease and are only diagnosed after evaluation for infertility. Women may present with menstrual irregularities, lower abdominal or pelvic pain, or abnormal vaginal discharge. Given the low sensitivity of diagnostic tests, various composite reference standards are used to diagnose FGTB, including some combination of endoscopic findings, microbiological or molecular testing, and histopathological evidence in gynecological specimens. Early treatment with a standard regimen of a two-month intensive phase with isoniazid, rifampin, ethambutol, and pyrazinamide, followed by a four-month continuation phase with isoniazid and rifampin, is recommended to prevent irreversible organ damage. However, even with treatment, FGTB can lead to infertility or pregnancy-related complications, and stigma is pervasive.

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Endoscopic Findings of Female Genital Tract Tuberculosis: A 3-year Analysis at a Referral Center

Abstract: Objective: To study the laparoscopic and hysteroscopic appearances of female genital tract tuberculosis (FGTB).Study design: This is a hospital-based prospective observational study.

Cited by 4 publications

References 105 publications

Comparative study on complications and difficulties in laparoscopy in female genital tuberculosis cases versus non-tuberculosis cases

Comparative study on complications and difficulties in laparoscopy in female genital tuberculosis cases versus non-tuberculosis cases

JB Sharma’s white cotton ball sign: A new laparoscopic sign in abdominopelvic tuberculosis

Female Genital Tuberculosis

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