JB Sharma's white cotton ball sign: A new laparoscopic sign in abdominopelvic tuberculosis

Abstract

Background: Abdominopelvic tuberculosis (TB) is a variant of extrapulmonary TB causing significant morbidity, including infertility. Materials and Methods: Results of 87 cases of diagnostic laparoscopy in cases of abdominopelvic TB diagnosed on composite reference standard (CRS) for demonstration of new laparoscopic white cotton ball sign are presented. Results: Mean age, parity and duration of infertility were 27.2 years, 0.21 and 3.1 years, respectively. Oligomenorrhoea and hypomenorrhea were seen in 35 (40.22%) and 32 (36.78%) cases, while infertility was seen in all 87 (100%) cases while abdominal mass was seen in 27 (31.03%) cases and pelvic mass in 37 (42.58%) cases. Positive acid fast bacilli on microscopy and culture of endometrial biopsy was seen in 3.34% and 6.89% cases while epithelioid granuloma was seen in 12.64% cases on endometrial biopsy and in 13.79% cases on peritoneal biopsy. Positive polymerase chain reaction was seen in all cases while definitive abdominal pelvic TB was seen in 35 (40.1%) cases and probable findings in 42 (48.27%) cases. A new laparoscopic white cotton ball sign (resembling a large white cotton ball) was observed in 5 (5.74%) cases and biopsy from 3 showed it to be epithelioid granulomas positive. Conclusion: Demonstration of a new white cotton ball sign on laparoscopy seems to be a useful finding in abdominal pelvic TB.

Keywords

• abdominopelvic tuberculosis
• acid fast bacilli
• gene xpert
• laparoscopy
• white cotton ball sign