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Inflammation of the uterine appendages (salpingoophoritis)
Last reviewed: 23.04.2024
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Salpingoophoritis - inflammation of the uterine appendages - is most common among inflammatory diseases of the internal genital organs (70%). The relative scarcity of isolated forms of inflammation of the uterine appendages (salpingitis and especially oophoritis) is explained by anatomical proximity and generality in blood and lymph circulation.
Inflammation of the uterine appendages is more common in women of reproductive age. The occurrence of salpingo-oophoritis is promoted (menstruation, abortion, labor, curettage of the uterus, intrauterine contraceptives, impaired personal hygiene and hygiene of sexual life.
The development of the inflammatory process in the fallopian tube always begins with the mucous membrane of the tube, striking then other layers. Further spread, the form of the disease, the features of the clinical course depend on the virulence of the pathogen and the state of the body's defenses.
Acute salpingitis is accompanied by the accumulation of liquid inflammatory exudate in the lumen of the uterine tube, which, poured into the abdominal cavity, often causes an adhesive process around the appendages of the uterus. Inflammation in the region of the ampullar and iritramural (uterine) divisions may lead to obstruction of the tube. Continued exudation is accompanied by the accumulation of serous fluid in the cavity of the tube, its significant increase and the formation of the saktosalpinx. When infected, the content of the tube is suppressed and a pyosalpinx appears. Further progression of the disease can lead to the spread of infection beyond the primary focus (tube) and involvement in inflammation of the uterus (endometritis), fiber (parametritis) and peritoneum (pelvioperitonitis) of the pelvis. Perhaps the emergence of generalized forms of septic infection. The pyosalpinx can be opened with an outflow of pus in the abdominal cavity or adjacent hollow organs (intestine, bladder, vagina). The conglomerate of tissues and organs formed around the pyosalpinx may involve the ovary. In such cases, there is a common purulent "sack" - a tube-ovarian abscess (adnecstrum, tubo-ovarian inflammatory tumor).
Stimulation of the inflammatory process of the appendages of the uterus and recovery of the patient is often incomplete. The disease often takes a chronic form, which is characterized by a recurring, with exacerbation, course. More and more often, erased and primarily chronic forms of inflammation of the uterine appendages (about 60%) are noted.
In inflammatory diseases of female genital organs, the lesion is most often localized in the appendages of the uterus. According to observations on patients hospitalized in the gynecological department of the emergency hospital, acute adnexitis was diagnosed in 76.1% of cases of acute inflammatory processes of the upper genital tract, and in 81.5% of cases the process was bilateral. From 42,8% to 75,9% of cases the inflammatory process in the appendages is combined with the endometritis.
As a causative agent of the disease is a wide range of microorganisms. Quite often, the cause of acute salpingitis is the gonococcus : these figures range from 16-23.8%. It should be borne in mind that in modern conditions gonococcal can cause inflammation in associations with other flora, for example with chlamydia, or create conditions for invasion of other microorganisms into the tubes, including non-spore forming anaerobes.
Chlamydia, mycoplasmas, various representatives of aerobic flora (staphylococcus, E. Coli, proteus, enterococci, Klebsiella, etc.) can serve as an etiological factor in the development of acute inflammation of the appendages, speaking in isolation or in association with each other, in the latter cases the disease is much heavier. Anaerobes (bacteroides, peptococci, pepto-streptococci, etc.), playing an important role in the development of acute salpingitis, are most often secondary infections, leading to a sharp deterioration in the clinical picture of the disease.
In the pathogenesis of acute inflammation of the appendages, the ascending pathway of infection is of primary importance. Predisposing factors are menstruation, use of IUD, various transcervical diagnostic and therapeutic interventions, abortion. The inflammatory process begins with endosalpingitis, then the submucosal layer, muscular and serous membranes are subsequently involved. In the lumen of the tube, a serous inflammatory exudate accumulates, which, as the process progresses, may become purulent. When adhering the uterine and ampullary ends of the tubes, a saccular formation (hydrosalpinx or pyosalpinx) is formed.
Clinical experience and data from morphological studies suggest that the ovaries are less often involved in acute inflammatory process. If oophoritis occurs, as a rule, it is secondary, ie, a consequence of the spread of infection from neighboring organs and tissues (uterine tube, appendix, sigmoid colon, peritoneum of small pelvis). First of all, acute periophoritis develops, in which the integumentary epithelium is affected; after ovulation, the cortical layer is involved in the inflammatory process. At the site of the bursting follicle or in the yellow body, an abscess can form, and when the ovary tissue is completely melted, the piovarium is formed. If there is an abscess in the ovary, in some cases, destruction of the surrounding tissue occurs and a single cavity with pyosalpinx is formed - a tubo-ovarian abscess. It is referred to as the "purulent inflammatory formation of the uterine appendages."
[Symptoms of acute inflammation of the appendages
Symptoms of acute inflammation of the appendages have a pronounced pattern
Symptoms of inflammation of the uterine appendages are determined by the etiology, degree and stage of the disease, the reactivity of the patient's body. Acute salpingo-oophoritis is characterized by severe pain in the lower abdomen, especially on the side of inflammation, an increase in body temperature. With the growth of the inflammatory process, the patient's condition worsens, symptoms of intoxication appear, pains intensify and can acquire a cramping character, the temperature becomes high and accompanied by chills, the symptoms of irritation of the peritoneum may be positive.
In the chronic stage of the process the pains acquire a dull, unstable character, intensifying during menstruation and with physical stress, after hypothermia. There are disorders of the nervous system, work capacity is reduced.
The adnexitis caused by anaerobic infection is most severe, especially in association with E. Coli and staphylococcus. Less symptomatic symptoms and a more protracted course are characterized by inflammatory processes, caused by chlamydia infection, mycollapse.
Inflammation of the appendages of the uterus (salpingoophoritis) - Symptoms
Diagnosis of inflammation of the uterine appendages (salpingo-oophoritis)
Diagnosis of acute affection of the appendages is based on the history of the disease, the features of the flow, the results of clinical, laboratory and apparatus research methods.
Studying the patient's anamnesis, one should pay attention to the characteristics of sexual life, previous transcervical diagnostic and / or therapeutic interventions, abortion, operations on the genitals, the presence and duration of use of the IUD. It is necessary to identify a possible relationship between the onset of the disease and the menstrual cycle: the ascent of infection into the desquamation phase. In the presence of a history of diseases with similar clinical manifestations, the duration of its course, the nature and effectiveness of therapy, predisposing factors (hypothermia, overfatigue, etc.), the presence of violations of the menstrual cycle and infertility.
Inflammation of the appendages of the uterus (salpingoophoritis) - Diagnosis
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Treatment of inflammation of the uterine appendages (salpingo-oophoritis)
Treatment of acute inflammation of the uterine appendages should be carried out only in a hospital. This rule extends to patients with acute course of the process without vivid clinical manifestations. The earlier the patient is hospitalized, the more timely the adequate therapy will be started and the more likely to reduce the number of possible adverse effects that are typical for this type of disease. Attempts to treat patients on an outpatient basis, according to our observations, almost 3 times increase the percentage of such immediate and remote complications as the spread of the inflammatory process and the formation of purulent foci in the small pelvis, the chronic disease, the violation of menstrual and reproductive functions, the development of ectopic pregnancy.
Patients need physical and mental rest. Depending on the features of the course of the disease for 3-5-7 days are assigned bed rest. From the diet exclude spicy dishes. For women with acute inflammatory diseases of the internal genital organs, especially in the recurring course of the chronic process, a variety of psychoemotional disorders (sleep, appetite disorders, increased irritability, fatigue, etc.) are characteristic. Therefore, to participate in the treatment of patients it is desirable to involve a psychotherapist, prescribe sedatives, hypnotics.
Inflammation of the appendages of the uterus (salpingoophoritis) - Treatment