A. Causative organism: mycobacterium tuberculosis (usually human type).
B. Mode of infection:
1) Blood born is the commonest.
3)Direct extension from the peritoneum.
C. Predisposing factors: poverty & immunosuppression.
A. Tubes: (affected in 100 % of cases)
– TB endosalpingitis: (the commonest form).
♦♦♦ Tube filled by caseous foci TB pyosalpnix.
– TB interstitial salpingitis:
♦♦♦ Tube becomes tortuous with dense adhesions
due to caseous foci within the muscle wall.
– TB perisalpingitis: part of pelvic TB peritonitis.
B. Uterus: TB endometritis in 50 % of cases.
C. Ovaries: in (25 %) of cases.
D. Cervix: commonly TB ulcer.
E. Vagina & vulva: very rare to be affected & usually TB ulcer.
– Infertility: the commonest symptom as (bad general condition, TB endometritis & TB salpingitis).
– Symptoms of pelvic congestion: congestive dysmenorrhea, menorrhagia & leucorrhea.
– Menstrual disturbances: amenorrhea, menorrhagia & metrorrhagia.
– Usually no abnormality detected & nodules may be detected in Douglas Pouch.
* To diagnose T.B. in general: CXR, sputum examination & tuberculin test.
* To diagnose genital TB:
1) PEB: part of specimen for histopathological examination & part for culture.
2) HSG: – Beaded & rigid pipestem tube.
– Dwarf uterus.
– Lymphatic intravasation.
3) Laparoscopy: detect TB salpingitis.
* Medical treatment:
1) Rest, diet & observation.
2) Anti-tuberculous drugs for ≥ 6 – 9 months.
3) Follow up by PEB after one year of treatment then every 6 months.
* Surgical treatment:
– Panhysterectomy in large masses.
Operative criteria of TB pyosalpnix;
1) Pallor of tissues é dense adhesions.
2) Sausage shaped.
3) Tubercles on the surface.
4) Patent abdominal ostium in many cases.
5) Fimbria: project like a tuft.
6) Caseous content.
Prognosis: * Pregnancy is rare to occur after medical treatment.
* Even if occur, it’s liable to abortion or ectopic pregnancy.
Management of pulmonary TB with pregnancy:
1) During pregnancy: give anti-tuberculous drugs.
2) Induction of abortion or labour: if there is early active infection.
3) The newborn: give BCG vaccine.
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