Salpingitis and Salpingo-oophoritis
– Bilateral affection of tubes is more common and usually associated with involvement of ovaries.
– Infection may be acute or chronic.
Causative Organisms:
– Neisseria gonorrhoeae, most common.
– Chlamydia trachomatis.
– Staphylococci, streptococci and E. coli. (Post traumatic e.g. labor and abortion).
– Tubercle bacilli.
– Actinomycosis.
Routes of Infection:
– Ascending infection: through lumen or lymphatics.
– Neighboring infected organ: as appendicitis and diverticulitis.
– Blood spread: as in tuberculosis from other distant sites.
Predisposing factors:
– Presence of source of infection.
– Lowered immunity and bad general conditions.
ACUTE SALPINGITIS
Definition: acute inflammatory reaction affecting fallopian tube.
Aetiology: as mentioned before.
Pathology:
* Acute catarrhal endosalpingitis:
– Mild condition restricted to endosalpnix.
– Mucous membrane shows congestion, hyperemia and oedema.
– Lumen filled with serous exudates.
– Complete resolution is usually suspected.
* Acute suppurative salpingitis:
– Severe condition affecting all layers of tube.
– Tubal wall (all layers) becomes infiltrated with polymorphs.
– The lumen filled with a purulent exudate.
– Although it is sever condition, but gangrene of tube NEVER occurs.
* Acute perisalpingitis:
– Perisalpnix is affected in;
– ascending infection through lymphatics (post traumatic).
– infected neighboring structures.
– Excessive adhesions surround the tube (fimbrial end may be closed).
Diagnosis:
* History:
– History of recent trauma (abortion, labour),
– History of recent instrumentation e.g. operation or examination.
– History of sexually transmitted disease e.g. gonococcal infection.
* Symptoms:
– Bilateral lower abdominal pain: sudden and sever pain usually present.
– Purulent vaginal discharge (blood stained in some cases).
– Vomiting and rigors as general symptoms.
– Frequency of micturition.
* Signs:
– General examination:
– Patient lie with flexed legs.
– Fever up to 40°C.
– Tachycardia.
– Abdominal examination:
– Abdomen usually distended.
– Tenderness and rigidity in lower abdomen.
– Maximal tenderness is at the tubal points.
– Vaginal examination:
– Severe pain on moving the cervix from side to side.
– Tenderness in both adnexae.
– Tenderness makes it difficult to felt uterus and adnexa.
* Investigations:
– Blood picture:
– Leucocytosis (25000 cell/ cmm), mainly polymorphs.
– Sedimentation rate: high.
– Ultrasonography: to exclude other causes of pain and tenderness (ectopic)
– Urine analysis: to exclude urinary tract infection.
* Differential diagnosis:
Acute appendicitis:
– Pain around the umbilicus radiated to the McBurny’s point.
– Low grade fever.
– Negative pregnancy test.
Acute appendicitis may be the cause of salpingitis.
– Acute cystitis and pyelonephritis:
– Loin pain and tenderness.
– Dysuria and other urinary symptoms.
– Urine analysis shows pus cells.
– Complicated ovarian cyst: (torsion, rupture).
– No history of infections.
– Swelling is unilateral, no marked fever.
– No leucocytosis.
Ultrasonography can diagnose it.
Ectopic pregnancy:
– Short period of amenorrhea.
– Pain is usually unilateral.
– Usually no fever and no leucocytosis.
– Positive pregnancy test.
– Ultrasonography may identify adnexal mass.
Treatment:
* General lines:
– Hospitalization.
– Bed rest in semi-sitting position.
– Light diet and IV fluids.
– Analgesics if diagnosis is definite.
* Antibiotic therapy:
– Broad spectrum antibiotic as cephalosporines.
– Metronidazole should be added for anaerobic organisms.
Antibiotic therapy should be guided by culture sensitivity.
A swab is taken from the cervix and upper vagina.
* Treatment of complications:
– Posterior colpotomy: if a pelvic abscess is formed.
CHRONIC SALPINGITIS
Aetiology:
– Usually follows acute or subacute infections (WHY?!!)
– Sometimes chronic from the start as in tuberculosis.
Pathology:
* Hydrosalpnix:
– Start as catarrhal salpingitis.
– Closed fimbrial end is by inflammatory oedema.
– Tube becomes a retort shaped swelling (Large) distended with clear serous fluid.
– Tubal content pass periodically from vagina (hydrops tubae profluens).
* Complications:
– Torsion and rupture.
– Pus formation (Pyosalpinx) formation due to secondary infection.
* Pyosalpinx:
– Start as suppurative (Sever) salpingitis.
– All layers of the tube are infiltrated with inflammatory cells (Thick and fibrous).
– Tube becomes a retort shaped swelling (small) distended with pus.
– Uterus may become fixed in retroversion.
* Complications:
– Rupture and peritonitis.
– Fistula formation, tubal abscess may open into the bladder, vagina or intestine.
– Acute exacerbations of salpingitis.
– Chronic manifestations of a septic focus.
* Chronic interstitial salpingitis:
– The main affected layer is musculosa.
– Interstitial abscesses formed within thick, fibrous wall.
– Salpingitis isthmica nodosa may develop.
– May affect tubal integrity predisposing to tubal ectopic pregnancy.
* Perisalpingitis:
– Adhesions around tube as a result of active infection.
– Complicated with tubal kinking, fixed RVF, or may intestinal obstruction.
* Tubo – ovarian cyst:
– Communication of both hydrosalpnix and follicular ovarian cyst.
* Tubo-ovarian abscess:
– Communication of both pyosalpnix and ovarian abscess.
* Chronic specific salpingitis:
– Caused by specific microorganisms e.g. Tuberculosis, Bilharziasis, or Actinomycosis.
Diagnosis:
Symptoms:
– Dull aching pelvic pain, which is chronic.
– Low backache which is constant.
– Dyspareunia of deep type.
– Congestive dysmenorrhea, menorrhagia, polymenorrhea, & leucorrhoea (Congested pelvis).
Complications:
– Tubal infertility (Disturbed tubal integrity).
– General complains of a septic focus.
– Recurrent attacks of acute salpingitis.
Signs:
General examination:
– Toxic manifestations of a chronic disease (pyosalpnix).
Abdominal examination :
– Lower abdominal tenderness especially tubal point.
Vaginal examination :
– Bilateral tender adnexae and bilateral swellings may be detected.
– Uterus may be felt RVF and may be fixed by adhesions.
– Frozen pelvis: this occurs in extensive cases.
Investigations:
– Ultrasonography: detect tubal and pelvic masses (Usually cystic).
– Laparoscopy: a respectable diagnostic method.
– Leucocytosis with sift to the right.
Differential diagnosis:
– Ovarian neoplasm.
– Endometriosis.
– Impacted posterior wall fibroid.
– Pelvic tuberculosis.
Treatment:
(A) Medical treatment:
* Application of local heat:
– Short wave therapy (3 times weekly for 8 weeks).
– Warm vaginal douches daily.
* Decongestant vaginal pessaries: (Glycerine Icthyol)
– Glycerine is hygroscopic decongests the pelvis by water absorption,
– Icthyol is soothing for pain.
* Drug therapy;
– Analgesics,
– Anti – inflammatory drugs,
– Antibiotics (Broad spectrum).
* Treatment of cervicitis:
– To prevent reinfection of the tubes.
(B) Surgical treatment:
* Indications:
– Failure of medical treatment and recurrent attacks of exacerbation.
– Tubal swelling of large size.
– Infertility.
* Conservative surgery:
– Indicated to restore fertility in cases of infertility,
– Salpingolysis: restore patency as it free the tubes from adhesions.
– Salpingostomy: Create a new opening in the closed fimbrial end.
– Resection and end to end anastomosis: of a destructed part of tube.
– Reimplantation of the tube into the uterus or hysteroscopic
catheterization for the blocked cornual end of the tube.
* Radical surgery:
– Salpingectomy;
– Removal of the affected tube with or without its ovary.
– TAH and BSO;
– Is the treatment of choice in women above 40 years with bilateral affection.
Salpingitis Isthmica Nodosa
Definition:
It is a disease process characterised by nodular thickenings at isthmical part of the tubes.
Aetiology: actually unknown;
Inflammatory: tuberculosis, gonorrhoea or Bilharziasis . (The most accepted cause).
Congenital: this is not accepted.
Adenomyosis: due to contiguous spread of the uterine adenomyosis .
Pathology: “Ross appearance:
– Bilateral with varying sized nodules from mm to 2.5 cm.
– Microscopic appearance:
– Gland – like spaces are scattered throughout the musculosa.
– Hyperplasia and hypertrophy of muscle fibres.
– The surrounding stroma is infiltrated with plasma cells or eosinophils.
Complications: Infertility and ectopic pregnancy.
Treatment:
– No specific treatment for non-symptomatising patient.
– ART for longstanding infertility .
Salpingitis, with Dr. Marc Steben
Salpingitis is an infection of the Fallopian tubes, the pair of tubes that connect the ovaries to the uterus. It is one of the main causes of preventable infertility. It is also known as pelvic inflammatory disease or PID, because the Fallopian tubes are rarely the only region infected. Salpingitis is usually caused by chlamydia or gonorrhea. Dr. Marc Steben explains here the principal causes, symptoms and treatments of salpingitis.
Tuberculous Salphingitis
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