1787 A Case of Female Genital Tuberculosis with Superimposed Tubo-Ovarian Abscess in a Developed Nation

Abstract

Video Objective To describe the surgical techniques in a case of female genital tuberculosis (TB) with superimposed tubo-ovarian abscess (TOA) in a developed country. Setting A 22-year-old G0 who was born in Vietnam presented to the emergency room with pelvic pain and known bilateral hydrosalpinx. She was treated for pelvic inflammatory disease, and a TB test was sent and later returned as positive. Her initial chest x-ray was read as normal. When she returned for follow up, a CT scan was planned to evaluate the extent of pulmonary and possible pelvic disease. However, before this could be done, she became febrile, requiring hospitalization with concern for TB or TOA. Interventions Once pulmonary and peritoneal TB were suspected based on imaging, diagnosis of TB was attempted via sputum culture and endometrial biopsy. However, there was significant concern that the patient had a tubo-ovarian abscess given the high fevers, dilated tubes, and delay in urogenital TB diagnosis confirmation. This led to the patient being taken to the operating room for diagnostic laparoscopy and drainage of the tube. This video shows the techniques used to evaluate pelvic organs when acute infection is suspected. Ultimately, the endometrial biopsy returned positive for culture of Mycobacterium tuberculosis, confirming the diagnosis of female genital tuberculosis. Conclusion This patient was diagnosed genital TB with superimposed bacterial infection, leading to the pyosalpinx. Female genital TB can cause a diagnostic challenge, and surgery may be required to achieve a diagnosis. Pre-operative planning and careful surgical technique is essential when faced with dense adhesions.