Laparoscopic Management of Tubercular Pyosalpinx Torsion in an Adolescent Girl: A Case Report

Abstract

Female genital tuberculosis (FGTB) is a form of extrapulmonary tuberculosis that predominantly affects women of reproductive age and is a significant cause of infertility in TB-endemic countries like India. Tubercular pyosalpinx is a rare presentation of FGTB. Even more uncommon is its complication by isolated tubal torsion, which may mimic other causes of acute abdomen, making early diagnosis challenging. We report the case of a 15-year-old girl who presented with acute lower abdominal pain and vomiting. She had a two-month history of low-grade evening fever. Clinical evaluation and ultrasound findings suggested pyosalpinx or hematosalpinx with normal ovarian morphology, raising suspicion of isolated tubal torsion. Diagnostic laparoscopy revealed a torsed, distended fallopian tube filled with purulent material and multiple peritoneal tubercles. The tube was excised using a glove-made improvised endobag to prevent intra-abdominal spillage. Histopathology confirmed tubercular salpingitis with caseous necrosis, and GeneXpert was positive for Mycobacterium tuberculosis. The patient was started on standard anti-tubercular therapy and had an uneventful recovery. This case underscores the importance of considering tuberculosis as an etiology in adolescent girls presenting with pyosalpinx, especially in TB-endemic regions. It also highlights the value of safe laparoscopic management with innovative surgical techniques in resource-limited settings. Early diagnosis, surgical intervention, and timely initiation of anti-tubercular therapy are crucial for effective management and preservation of reproductive health.

Keywords: Female Genital Tuberculosis; Laparoscopy; Pyosalpinx; Torsion.