Pelvic tuberculosis is mostly combined with tubal tuberculosis and can be divided into two types. One is wet peritonitis, which is mainly exudative, with numerous grayish-yellow nodules of different sizes scattered on the peritoneum, and the exudate is a plasma straw-yellow clarified fluid that accumulates in the pelvic cavity. The second is dry peritonitis, dominated by adhesions, also known as adhesive peritonitis, characterized by thickening of the peritoneum and close adhesions with adjacent organs, with blocks of adhesions, often with caseous necrosis and easy formation of fistulas.
Symptoms
When the endometrium is infected by the tuberculosis bacillus, it may start with symptoms of excessive menstruation or dripping bleeding due to inflammation and congestion of the endometrium or ulceration. If the disease is not diagnosed and treated in time, it can progress further and most of the endometrium is destroyed, so that menstruation becomes scanty, and finally all of the endometrium is destroyed and replaced by scar tissue, at which time menstruation stops. Patients with pelvic tuberculosis may have general symptoms of tuberculosis, such as low fever, night sweats, emaciation, and weakness, or they may have no symptoms at all.
Causes
The disease is mostly secondary to pulmonary tuberculosis. Among the genitalia, the fallopian tubes are the first to be infected, followed by the endometrium and the pelvic peritoneum. Ovarian and cervical tuberculosis are less common.
Countermeasures
Patients suffering from primary infertility, scanty or amenorrheic menstruation, chronic pelvic inflammatory disease that has been untreated for a long time, and a history of pulmonary and intestinal tuberculosis may suffer from this disease and may ask their doctor to take the endometrium for pathological examination. If the diagnosis is confirmed, the patient should receive regular treatment in a hospital. Prevention of pelvic tuberculosis can be achieved by strengthening exercise, improving physical fitness, getting BCG vaccination, and actively preventing and treating pulmonary, lymphatic and intestinal tuberculosis.
Treatment
Once the diagnosis of pelvic tuberculosis is clear, regardless of the severity of the disease, active treatment should be given, especially to patients with mild disease, it is difficult to be sure whether the lesions have been quiescent or cured.
The current treatment of pelvic tuberculosis includes general treatment, anti-tuberculosis drug therapy and surgery.
General treatment of pelvic tuberculosis
Like tuberculosis of other organs, pelvic tuberculosis is a chronic wasting disease. The strength of the body’s immune function plays an important role in controlling the development of the disease, promoting the healing of lesions, and preventing recurrence after drug treatment. After the lesion is suppressed, the patient can engage in light activities, but should also pay attention to rest, increase nutrition and vitamin-rich food, have sufficient sleep at night, and have a happy spirit. In particular, infertile women should be comforted and encouraged to relieve their worries in order to facilitate the recovery of their general health.
Anti-tuberculosis drug treatment for pelvic tuberculosis
The advent of anti-tuberculosis drugs has brought about a great change and leap in the treatment of tuberculosis, and most of the other treatment measures have been abandoned, and cases requiring surgery in the past have been replaced by safe, simple and more effective drug therapy. However, in order to achieve the desired efficacy, the five principles of rationalized treatment must be implemented, namely early, combined, appropriate, adequate and regular use of sensitive drugs. Early tuberculosis lesions are in the bacterial multiplication stage, the earlier the lesions are fresh, the better the blood supply, and the easier the drugs penetrate; aggressive treatment can prevent delays and the formation of intractable chronic caseating lesions.
The combination of drugs can kill naturally drug-resistant bacteria or prevent multiplication, and the chance of producing drug-resistant tuberculosis bacteria is greatly reduced, but because of the long course of drug therapy, patients are often not easy to adhere to, and there are cases of premature discontinuation of drugs or irregular dosing, resulting in treatment failure. For this reason, clinicians should pay more attention to the two principles of regularity and adequacy, pay attention to the patient’s treatment, and strengthen supervision of the patient to avoid stopping or arbitrarily changing medication in the middle of treatment, which may lead to incomplete treatment, resulting in drug resistance and difficult treatment.
Since the number of pelvic tuberculosis patients is relatively small, it is difficult to conduct a good clinical control trial, so the treatment plan used is derived from the experience in the treatment of pulmonary tuberculosis.
Surgical treatment of pelvic tuberculosis
Anti-tuberculosis medication is preferred for pelvic tuberculosis, and surgery is generally not performed. In order to avoid the spread of infection during surgery, to reduce the difficulty of surgical operation due to extensive adhesions and congestion of pelvic organs, and to facilitate the healing of the abdominal wall incision, antituberculous treatment should be given for one or two months before surgery.
Anti-tuberculosis treatment should be given only after.
① 6 months of drug treatment and persistence of pelvic mass;
②Multiple drug resistance;
③ Symptoms (pelvic pain or abnormal uterine bleeding) persist or recur;
④Recurrence of lesions after drug treatment;
⑤ Failure to heal the fistula;
(6) Surgery should be considered when there is a suspicion of genital tract tumor.
Although surgical complications are now rare, a high degree of vigilance should be exercised at the time of surgery. If the adhesions are severe and the adjacent organs are damaged during separation, fistula may occur, so forceful blunt stripping should be avoided when separating the adhesions. Once the separation line is made between the organs, a mirror stripping should be performed, with less cutting each time and in a gradual manner. The adhesions between old intestinal tubes need not be separated.
The healing adhesions can remain in a small part of the uterine wall or fallopian tube attached to the intestine or bladder, which is safer than forcible removal of all of them. In case of severe and extensive pelvic organ adhesions, the round ligament should be identified and the uterine fundus should be freed first to facilitate the direction of surgery and stripping.
If there is a fistula formed by pelvic tuberculosis, a urinary tract and whole gastrointestinal tract X-ray should be performed before surgery to understand the full extent of the fistula before proceeding. Neomycin is started several days before surgery for intestinal preparation.
If the uterus and bilateral adnexa have been completely removed, and all intra-abdominal lesions have been eliminated without coexisting tuberculosis in other organs, anti-TB treatment for one or two months after surgery is sufficient to avoid recurrence.