Overview of acute endometrial tuberculosis

Endometrial tuberculosis is an inflammation of the endometrium caused by Mycobacterium tuberculosis. It is usually a part of pelvic tuberculosis and also a part of systemic tuberculosis. The main source of infection is pulmonary or peritoneal tuberculosis. Endometrial tuberculosis accounts for 50-60% of genital tuberculosis. It often spreads from fallopian tube tuberculosis to the uterus, and the lesions are mostly confined to the endometrium.

Clinical manifestations

1. Irregular menstruation

Due to the influence of tuberculosis, the endometrium may become congested or form ulcers in the early stage, resulting in menorrhagia; in the late stage, the endometrium is damaged, affecting its function, causing infrequent menstruation or even amenorrhea.

2. Infertility

Because tuberculosis of the endometrium destroys the environment for the implantation and development of the fertilized egg, or tuberculosis of the fallopian tubes blocks the fallopian tubes and causes infertility, many patients come to the hospital for examination because of infertility, and are finally diagnosed with endometrial tuberculosis.

3. Lower abdominal pain

It is mostly caused by combined pelvic tuberculosis, which leads to pelvic congestion, adhesion or abscess formation, resulting in lower abdominal pain.

4. Systemic symptoms

In severe cases, systemic symptoms such as fatigue, night sweats, low fever, weight loss and loss of appetite may occur.

treat

1. Anti-tuberculosis treatment

At present, anti-tuberculosis treatment adopts short-term combination drug therapy, which shortens the medication time, reduces the medication dosage, alleviates the toxic reactions of drugs, and is easier for patients to accept. When using the medication, it is necessary to pay attention to the fact that anti-tuberculosis drugs may cause toxic reactions in some patients, such as nerve damage, liver and kidney function damage (including jaundice), and make appropriate treatment according to the specific situation of the patient.

2. Surgery

(1) Indications for surgery ① The symptoms of tubo-ovarian abscess subsided after drug treatment, but the mass did not disappear, and the patient felt that the symptoms recurred. ② Patients with ineffective drug treatment and tuberculous abscesses. ③ Patients with large encapsulated effusions. ④ Patients with extensive endometrial destruction and ineffective anti-tuberculosis drug treatment. ⑤ Patients with tuberculous peritonitis and ascites. Surgical treatment combined with drug treatment is beneficial to the recovery of peritoneal tuberculosis.

(2) Surgical method: If the patient requests to preserve fertility, the uterus can be preserved if the endometrial tuberculosis lesions have healed. For patients whose fallopian tubes and ovaries have formed large masses and cannot be separated, hysterectomy can be performed.

(3) Scope of surgery The scope of surgery should be determined based on age and the extent of the lesion. Since most patients are women of childbearing age, when surgery is necessary, consideration should also be given to preserving the patient's ovarian function.

(4) Special circumstances: Adhesions caused by pelvic tuberculosis are often extremely extensive and dense, making surgical separation difficult. If forced, it may cause unnecessary damage. In such circumstances, the surgeon should stop the operation immediately and perform anti-tuberculosis treatment for 3 to 6 months after the operation. A second operation may be performed if necessary.