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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This case report describes an infertile patient with known endometriosis who developed acute abdomen due to a flare-up of undiagnosed abdominal tuberculosis following hysterosalpingography. The procedure caused contrast extravasation, which exacerbated the subclinical infection and led to diffuse peritonitis requiring explorative laparotomy and antitubercular treatment. The authors highlight that while HSG is standard in infertility workups, it carries significant risks in patients with female genital tuberculosis, often leading to diagnostic challenges when symptoms mimic other conditions. Relevance to endometriosis: This paper discusses endometriosis as a comorbid condition in a patient whose acute presentation was actually driven by a tubercular flare-up triggered by diagnostic testing.

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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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