Sharma’s abdominal compartmentalization sign: A new laparoscopic sign for abdomino-pelvic tuberculosis

Abstract

Abstract Aim To evaluate a new laparoscopic sign “Sharma's abdominal compartmentalization sign” in abdominopelvic tuberculosis in women with infertility. Methods A total of 167 women diagnosed to have abdomino-pelvic tuberculosis, on endometrial sampling for acid fast bacilli on microscopy or culture, polymerase chain reaction or epithelioid granuloma on histopathology or on laparoscopy or hysteroscopy were enrolled in this ongoing study on tuberculosis in infertility. A new laparoscopic finding “Sharma's abdominal compartmentalization sign” was studied in these womenduring laparoscopy. Results The mean age, parity and duration of infertility was 28.3 years, 0.28 and 2.42 years respectively. Various presenting symptoms were menstrual dysfuction like hypomenorrhoea (11.97%), oligomenorrhoea (13.17%) along with constitutional symptoms and abdomino pelvic pain or mass. Diagnosis of abdominopelvic tuberculosis was made by identification of acid fast bacilli (AFB) on microscopy or culture of endometrial aspirate or peritoneal biopsy or positive gene Xpert or positive polymerase chain reaction (PCR) or histopathological demonstration of epithelioid granuloma on endometrial or peritoneal biopsy. Various laparoscopic findings on pelvic and abdominal organs were either definite findings of TB like tubercles, caseous nodules or beaded tubes or probable findings of TB like encysted ascites, abdominal and pelvic adhesions, straw colored fluid, perihepatic adhesions or tubal findings like hydrosalpinx, pyosalpinx, or calcified tubes. A new “Sharma's abdominal compartmentalization sign” in which abdominal cavity was divided into compartmental by adhesions possibly to contain infection to defined areas was observed in 18 (10.73%) cases. Conclusion Diagnostic laparoscopy is a useful investigation for abdominopelvic tuberculosis showing various findings including new ‘compartmentalization sign’.