Pioalpinx and tubo-ovarian abscess

Pioalpinx is an accumulation of pus in the fallopipe with salpingitis.

Tuboovarial abscess is a cavity in the area of the fallopian tube and ovary, containing pus and delimited from surrounding tissues by a pyogenic membrane. The expressed clinical picture is observed at rupture of an abscess and hit of its contents in an abdominal cavity.

[1], [2], [3]

Symptoms of the pyosalpinx and tubo-ovarian abscess

• pain in the abdomen before admission to hospital;
• generalized pain throughout the abdomen when pus enters the abdominal cavity;
• irradiation of pain in the upper quadrant of the abdomen, lower back;
• increased pain during movement;
• forced position of the body;
• chills, tachycardia, lowering of blood pressure;
• general malaise, weakness, loss of appetite;
• nausea, vomiting, diarrhea;
• fever (38-40 ° C);
• purulent discharge from the vagina;
• positive symptoms of irritation of the peritoneum;
• increased pain when the cervix is displaced;
• palpation of tumor-like formation from one or sides of the uterus, painful, with indistinct contours.

Diagnostics of the pyosalpinx and tubo-ovarian abscess

When diagnosing, it is necessary to take into account:

• history data (the presence in the past of inflammatory diseases of the genitals, foci of chronic infection in a woman);
• data of objective research, which allow to identify purulent-inflammatory process in the pelvis; when carrying out laboratory blood tests, leukocytosis is determined with a shift toward polymorphonuclear cells, an increase in LII to 10, an ESR of up to 30 mm / h, and sometimes moderate anemia.

Laparoscopy allows you to verify the diagnosis and in some cases to perform surgical treatment.

[4], [5], [6], [7], [8]

Differential diagnosis

Differential diagnosis of pyosalpinx and tubo-ovarian abscess:

• uterine or ectopic pregnancy;
• torsion of the leg of the ovarian cystadenoma or the subserous myoma of the uterus;
• appendicular infiltration.

[9], [10], [11], [12], [13]

Treatment of the pyosalpinx and tubo-ovarian abscess

Precise diagnosis and exclusion of rupture of the abscess wall are extremely important for the choice of treatment.

At the initial stages, conservative therapy is carried out, which includes:

• bed rest;
• correction of disturbance of water and electrolyte balance, immunomodulators;
• sedatives, desensitizing agents;
• antibiotics intravenously, metronidazole;
• if there is an IUD - removing it;
• drainage of inflammatory formations and pelvic abscesses.

Indications for surgical treatment:

• absence of the effect of intensive conservative therapy within 4 hours of its conduct;
• perforation of pyosalpinx or tubo-ovarian abscess, diffuse peritonitis;
• infectious-toxic shock.

The volume of surgical treatment is determined individually. Extirpation or supravaginal amputation of the uterus with one- or two-side removal of the appendages is performed in the following clinical situations:

• when the patient is seriously ill and forming multiple intra-abdominal abscesses;
• with diffuse purulent peritonitis;
• with primary involvement in the process of the uterus (after childbirth, abortion, IUD);
• with bilateral tubo-ovarian abscesses in the pelvis.

At a young age, removal of the uterus should be the exception rather than the rule. It is necessary to use the most minimal possibility for preservation of ovarian tissue.