Acute abdomen after hysterosalpingography-flare up of subclinical abdominal Kochs or endometriosis, a diagnostic dilemma

Vijayalakshmi Shanbhag, Pushpawati Thakur, Jyotsna Kashibhatla, Sarita Agrawal, Sarita Rajbhar, Tithi Barman
In: International Journal of Research in Medical Sciences · 2023 · vol. 11(11) , pp. 4235–4238 · doi:10.18203/2320-6012.ijrms20233410 · W4388073637
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This case report details a patient with endometriosis and undiagnosed abdominal tuberculosis whose condition worsened after hysterosalpingography, leading to acute abdomen and requiring surgical intervention and antitubercular treatment.

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Abstract

Here we present the case report of a patient of infertility with endometriosis and undiagnosed underlying abdominal Kochs that exacerbated after hysterosalpingography (HSG), presenting as acute abdomen and causing a diagnostic dilemma. (HSG) is a diagnostic test used to evaluate the fallopian tubes and uterus. HSG is contraindicated in FGTB as it can result in flare-up of subclinical infection. However, it is often performed as part of infertility workup in unsuspected cases. In our patient the unsuspected preexisting abdominal Kochs got flared up after extravasation of the contrast material during HSG resulting in formation of pus and diffuse peritonitis. Explorative laparotomy was taken after 1 week of conservative management and pus drained along with ovarian cystectomy. The patient was started on antitubercular treatment postoperatively and recovered well.
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Acute abdomen after hysterosalpingography-flare up of subclinical abdominal Kochs or endometriosis, a diagnostic dilemma DOI: https://doi.org/10.18203/2320-6012.ijrms20233410Keywords: Abdominal Kochs, HSG, Tubercular abscess, FGTBAbstract Here we present the case report of a patient of infertility with endometriosis and undiagnosed underlying abdominal Kochs that exacerbated after hysterosalpingography (HSG), presenting as acute abdomen and causing a diagnostic dilemma. (HSG) is a diagnostic test used to evaluate the fallopian tubes and uterus. HSG is contraindicated in FGTB as it can result in flare-up of subclinical infection. However, it is often performed as part of infertility workup in unsuspected cases. In our patient the unsuspected preexisting abdominal Kochs got flared up after extravasation of the contrast material during HSG resulting in formation of pus and diffuse peritonitis. Explorative laparotomy was taken after 1 week of conservative management and pus drained along with ovarian cystectomy. The patient was started on antitubercular treatment postoperatively and recovered well. Metrics References Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis. 2015;78:47-55. Bellelis P, Dias JA, Podgaec S, Gonzales M, Baracat EC, Abrao MS. Epidemiological and clinical aspects of pelvicendometriosis: series of cases. Rev Assoc Med Bras. 2010;56(4):467-71. Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018;148(1):S71-83. Namavar JB, Parsanezhad ME, Ghaneshirazi R. Female genital tuberculosis and infertility. Int J Gynaecol Obstet. 2001;75:269-72. Schaefer G. Female genital tuberculosis. Clin Obstet Gynecol. 1976;19:223. Parikh FR, Nadkarni SG, Kamat SA. Genital tuberculosis-a major pelvic factor causing infertility in Indian women. Fertil Steril. 1997;67(3):497-500. Schaefer G. Tuberculosis of the female genital tract. Clin Obstet Gynecol. 1970;13(4):965. Ghosh SB, Mala YM, Tripathi R, Tyagi S. Coexisting genital tuberculosis and endometriosis presenting as abdominal mass in an infertile woman: a report of a rare case. Fertil Steril. 2008;90(2):443.

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endometriosisinfertility

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