Sactosalpinx

The female reproductive system is a complex mechanism. Unfortunately, sometimes in it there are quite serious "breakdowns" of diseases that prevent the system from functioning normally. One of the specific pathologies is sacctosalpinx: such a violation occurs in one of the fallopian tubes. In it, serous fluid accumulates, blocking the patency.

Sactosalpinx is a complex disease that causes numerous disorders in a woman's body, negatively affecting the ability to become pregnant and give birth to a child. However, this disease can and should be combated by starting treatment as early as possible. [1]

Epidemiology

According to the information provided by the World Health Organization, approximately 15% of couples in the world face difficulties in trying to conceive a baby. In every second case, the problem is caused by problems in the female body.

About 2% of women of childbearing age are diagnosed with "primary infertility". In this case, the most common cause of this diagnosis is a violation of tubal patency. And, in turn, one of the causes of such a violation is often a sactosalpinx.

The Association of Obstetricians and Gynecologists estimates the prevalence of sactosalpinx among infertile patients to be between 7 and 28%. Often the problem is discovered accidentally - for example, during complex diagnostics in case of inability to conceive. Unilateral or bilateral sactosalpinx is more often diagnosed in patients under the age of thirty.

Sactosalpinx is very rarely a primary pathology. As a rule, this disease becomes a consequence of other gynecological problems - for example, inflammatory specific or nonspecific infections.

Causes of the sacrosalpinx

The most common cause of infertility doctors call disorders related to the patency of the Fallopian tubes. In such cases, a diagnosis of so-called "mechanical" infertility is made. What are the tubes of the uterus? These are paired hollow tubular formations that connect each of the ovaries with the uterus. That is, one end of the tube is connected to the uterus, and the other end of the extended funnel-shaped segment goes into the abdominal cavity in the area of localization of the ovaries.

The ovum matures in the ovary and, when it is released from the follicle, it enters the tube, moving towards the uterus. The sperm moves towards it - from the vagina to the uterine cervix and into the uterine cavity, then into the tube. Further, much depends on the functionality of the tube, which should facilitate the meeting of sperm with the egg. With a positive outcome comes fertilization, the zygote begins to move towards the uterine cavity: it helps her in this ciliated epithelium present inside the tubes. Once it reaches the uterus, the embryo is anchored in the wall of the organ: from this moment, the direct process of gestation begins.

What can be understood from the above mechanism? If there is any obstruction in the path of the egg or sperm, if the cilia inside the tube are damaged, the pregnancy becomes jeopardized or an ectopic pregnancy develops.

Under what circumstances can a sactosalpinx, a neoplasm that interferes with normal tubal function, occur? It can be caused by:

• Genitourinary infections, including sexually transmitted diseases;
• inflammatory diseases affecting the uterus, tubes, ovaries;
• formation of adhesions after inflammatory processes, surgeries, induced abortions, etc.;
• pelvic congestion;
• regular or severe hypothermia;
• allergic processes;
• purulent diseases involving the abdominal organs;
• endometriosis.

A particularly common cause of sacrosalpinx is untreated inflammation of the reproductive organs - in particular, salpingo-ophoritis.

Risk factors

Factors that increase the predisposition of the body to develop sacctosalpinx are considered to be:

• pelvic inflammatory disease;
• frequent or severe hypothermia;
• promiscuous sexual intercourse, unprotected intercourse;
• hard physical labor;
• obesity.

Inflammatory infectious processes of the reproductive organs (especially of a chronic nature) contribute to the development of sactosalpinx - it can be adnexitis, salpingitis, endometritis. "The culprits" are often endometriosis, surgical interventions (even removal of appendicitis). Almost any abdominal surgery can be complicated by the formation of adhesions and deterioration of tissue circulation.

As a result of the inflammatory process, the uterine canal becomes "glued", which often happens when the infection travels from the uterus to the ovaries. In salpingitis - isolated tubal inflammation - adhesions are formed, which also lead to obstruction. Adhesions are a kind of connective tissue threads that squeeze the uterine canals and disrupt their patency. Additional negative impact is caused by endometriosis - pathological overgrowth of tissues similar in structure to the mucous tissue of the uterine cavity.

In fact, any factor that contributes to the compression of the tubes and the formation of cavities in them can serve as a "trigger" to the development of sactosalpinx.

Pathogenesis

Sactosalpinx is a hollow round neoplasm located in the fallopian tube. In this formation there is a gradual accumulation of exudative fluid - more often serous, less often - purulent character. When pus accumulates, it is said about the development of pyosalpinx.

Sactosalpinx, gradually increasing in size, begins to block the lumen of the fallopian tube, which makes it difficult or impossible to move the oocyte to the uterus.

In some cases, the pressure of the accumulated exudate becomes such that the neoplasm "bursts" and fluid enters the uterine cavity. This outcome does not guarantee that the neoplasm will not reappear after rupture.

When fluid breaks into the abdominal cavity, the clinical picture of acute peritonitis rapidly develops. This condition is an emergency and threatens the life of the patient. It is necessary to urgently proceed to surgical intervention.

Sactosalpinx can be unilateral (in one tube) or bilateral (in two tubes). It can have an acute or chronic sluggish course. About simple sactosalpinx is said if there is only one formation with fluid. Multiple neoplasms allow us to talk about follicular sacctosalpinx.

Symptoms of the sacrosalpinx

Early stages of sacctosalpinx proceed without specific symptomatology. The subsequent clinical picture depends on the type and intensity of the pathological process, age and individual characteristics of the patient. Other background diseases also play an important role.

The first signs of a malfunction may be as follows:

• severe pain syndrome with the onset of the monthly cycle (even disturbances of consciousness are possible);
• monthly cycle irregularities;
• alternating pulling and sharp pains in the groin and pubic area;
• abnormal vaginal discharge;
• General discomfort, apathy, irritability, sleep disturbances, constant feeling of fatigue;
• elevated body temperature;
• arrhythmias.

These symptoms can occur together or separately. However, the main symptom that is found in all patients is futile pregnancy attempts or tubal pregnancy.

The disease rarely takes an acute course. More often, the symptomatology increases slowly, gradually. Temperature in sacrosalpinx also "behaves" differently:

• against the background of serous inflammatory process, the temperature is kept within subfebrile parameters;
• in purulent-serous inflammatory process, the values rise to 38°C;
• in purulent process (pyosalpinx) there is an increase in temperature up to 39 ° and even more.

The pain is predominantly in the groin area, on the left, right, or all over the groin. The pain can be pressing, squeezing, pulsating. Among the general symptoms, one can pay attention to general weakness, fatigue, increased sweating, signs of intoxication (headache, apathy, gray skin tone, tachycardia, etc.).

The chronic form of sacctosalpinx is more often asymptomatic or asymptomatic. In many patients, the only manifestation of the malfunction is the inability to become pregnant. With a significant size of the neoplasm, a woman may complain of a feeling of pressure, heaviness in the lower abdomen. If sacctosalpinx exists against the background of adhesions, the characteristic symptom is the so-called chronic pelvic pain syndrome: unpleasant sensations increase with physical activity, hypothermia, during sexual intercourse. Temperature rise is noted only in the period of exacerbation and manifested by subfebrile indicators. If the disease process spreads to the ovaries, then patients complain of a disorder of the monthly cycle, irregularity of menstruation. A characteristic symptom indicating a ventral sacctosalpinx is intense liquid vaginal discharge that occurs from time to time.

Sactosalpinx and pregnancy

If the patency of the fallopian tubes is impaired, fertilization actually becomes impossible: doctors diagnose a woman with mechanical infertility. Problems may also arise in case of damage to the muscular tubal layer or the mesenteric epithelium. In such situations, the movement of the zygote to the uterine cavity will be difficult. As a result, there are significant risks of ectopic (tubal) pregnancy.

As a rule, sactosalpinx strongly and negatively affects the functionality of the fallopian tube. Additional unfavorable effects have connective tissue overgrowths, scarring changes and adhesions. All these are signs that are present to a greater or lesser extent in most patients who have undergone inflammatory processes in the pelvic organs.

How does the formation of sacrosalpinx occur? The villi lose the ability to function adequately, smooth muscle fibers stop contracting properly, the lumen of the tube fills with adhesions and "glues". If "gluing" occurs at both ends of the tube, then in the formed void over time accumulates produced by cells mucous secretion, which leads to a gradual expansion of the tube and the formation of a sac-like formation. In some patients, the so-called valve sactosalpinx is formed, which is a periodically ruptured formation with regular emptying of the tube.

Is pregnancy possible under these conditions? Sactosalpinx not only significantly reduces the chances of fertilization, but also increases the likelihood of ectopic pregnancy. Most often, doctors turn to surgeons and reproductologists for help: the woman has the affected tube removed and then begins preparations for in vitro fertilization (IVF).

Sactosalpinx and IVF

A few decades ago, the operation of reconstruction and restoration of the tubal patency was always prescribed in case of sactosalpinx. However, many years of practice have shown that the probability of getting pregnant increases significantly when using assisted fertilization methods - in particular, IVF. This procedure does not involve the affected tube, as the gametes are joined not in it, but inside the tube, which eliminates the risk of tubal pregnancy.

Nevertheless, IVF against the background of sacctosalpinx can also end badly, because it is not excluded the possibility of getting toxic exudate from the sac-like formation into the uterine cavity. Toxins can negatively affect the strengthening of the embryo, creating an unsuitable environment for the qualitative development of the fetus. It is this fact that explains the inability to get pregnant or bear a child by patients with a unilateral tubal problem. Even if nothing prevents the passage of the ovum through the other tube, the embryo's attachment and development in the uterus becomes impossible.

Based on this, experts recommend to first remove the tube affected by sactosalpinx, and then start preparing for IVF procedure. As a rule, beforehand, a woman is carried out a number of diagnostic examinations - ultrasound, X-ray examination. If a woman has already undergone IVF against the background of saktosalpinx, and the procedure was unsuccessful, she is mandatorily prescribed surgical treatment. Surgery - salpingectomy - is performed by laparoscopy.

Stages

Sactosalpinx is classified not only by type, but also by stage: this is necessary to determine the need for surgical treatment and to assess the chances of a woman to restore tubal function.

As a rule, four stages of the disease process are distinguished:

1. The first stage is characterized by minimal adhesions, satisfactory tubal patency with preserved tubal folding.
2. Stage II: the presence of adhesions is estimated at 50%, there is occlusion of the distal tubal segment with preserved folding.
3. Stage 3: presence of adhesions - more than 50%, there is occlusion of the distal tubal segment with disturbed folding.
4. Stage four: there is no visibility of the ovarian surface, there is a formed sactosalpinx on the background of destroyed folding.

The fourth stage is considered the most serious, in which the entire surface of the ovary is covered with dense adhesions, and there is a sactosalpinx. Spontaneous pregnancy in this case is unlikely (about 8%), so the patient is recommended to seek assisted reproductive technologies.

Forms

The classification of sactosalpinx is quite extensive, as it includes all the criteria necessary for an accurate description of the diagnosis. Thus, the doctor necessarily describes the type of fluid present inside the formation, its exact location inside the fallopian tube, structural features, type of course, the probability of independent exit of secretory fluid.

Distinguish between these types of pathology:

• Serous sacrosalpinx (also called hydrosalpinx) is characterized by the accumulation of serous secretion with impaired outflow. The inflammatory process may be absent or just beginning to develop.
• Purulent sacrosalpinx (pyosalpinx) - characterized by an accumulation of purulent secretion against the background of the development of a specific or nonspecific inflammatory process.
• Unilateral or bilateral process - represents the accumulation of exudative fluid either in only one Fallopian tube - for example, sactosalpinx on the right, on the left, or in two tubes at the same time. Bilateral sacctosalpinx is much less common (only 15% of cases), is often follicular (multiple) and is accompanied by pronounced symptoms.
• Simple sactosalpinx - manifested by the presence of only one cavity with fluid.
• Follicular sacctosalpinx - manifested by the presence of several cavities with fusions between them.
• Acute sacrosalpinx is an active form of the disease, which is characterized by an abrupt onset and a violent clinical picture. The cavity with discharge is formed rapidly, which requires immediate medical attention.
• Chronic process, or sluggish, is characterized by a slow progressive course, gradual development, unexpressed clinical manifestations. Sometimes there are no complaints from the patient at all, and the only sign of pathology is infertility.
• Permanent sactosalpinx is a painful process that does not involve the exudative fluid coming out on its own.
• Ventilated sactosalpinx, aka ventilated, may be accompanied by periodic outflow of exudative secretion into the uterine cavity, and from there through the vagina to the outside.

In addition, when making a diagnosis, it is important to take into account the type of structural structure of the cavity formation. This is necessary for differential diagnosis with cystic and malignant elements.

Complications and consequences

Sactosalpinx, complicating, in almost all cases causes tubal infertility. Often the tube is surgically removed. Its improper function, inflammatory process can provoke such unfavorable consequences:

• ectopic pregnancy;
• accumulation of purulent exudate (pyosalpinx);
• acute inflammatory process - pelvio-peritonitis;
• infiltrates, abscesses in any part of the abdominal cavity and retroperitoneum;
• the formation of pelvic adhesions;
• inflammatory processes in nearby organs (salpingitis, endometritis, etc.).

The first danger of sacrosalpinx is the development of tubal infertility. Since the fluid accumulates in the tube, its patency is completely blocked. Accordingly, the egg loses the ability to penetrate the ampullary segment of the fallopian tube and into the uterine cavity. As a result, pregnancy cannot occur, or the chances of fertilization are reduced to 6%.

There is a risk of developing a life-threatening complication - we are talking about tubal rupture, with penetration of accumulated exudate into the abdominal cavity. As a result, an acute inflammatory process develops - peritonitis or pelvio-peritonitis. When pyosalpinx develops, purulent discharge can "break through" not only into the peritoneum, but also inside the vagina, rectovaginal cavity, bladder, or increase in the type of a limited abscess of rectovaginal-uterine cavity.

Diagnostics of the sacrosalpinx

It is practically impossible to diagnose sacrosalpinx based only on the patient's complaints. Therefore, diagnosis should be comprehensive, with specific tests that help to detect the accumulation of fluid in the lumen of the fallopian tube. Most often doctors use such diagnostic methods:

• Bimanual examination, gynecologic examination allows to detect palpable smooth voluminous dense-elastic and non-painful element.
• Ultrasound - helps to detect voluminous fluid formation, absence or smoothing of tubal folding.
• Ultrasound hysterosalpingography - indicates fluid accumulation and enlargement of the uterine cavity.
• Contrast hysterosalpingography - helps to detect obstruction of one or two tubes, and in case of ventral sacctosalpinx - bulbous dilation of the affected tube.
• Endoscopy in the form of laparoscopy or fertiloscopy allows you to visualize the tube with pathological dilation, detect adhesions and areas affected by endometriosis.

Laboratory tests are auxiliary diagnostic methods. PCR results are considered indicative: the study helps to identify the most likely causative agents of the infectious process associated with sacrospinx.

Instrumental diagnosis is primarily based on checking the patency of the Fallopian tubes. This can be done with the help of ultrasound, radiological method or surgical intervention. A certain agent (gaseous or liquid) is introduced into the uterine cavity, after which the doctor determines the quality of penetration of this agent through the tubal lumen into the abdominal cavity. Free movement of the agent indicates good tubal patency, while its delay indicates obstruction.

The verification procedure can be invasive (laparoscopy) or non-invasive (hysterosalpingography, ultrasound, pertrubation). Laparoscopy is always more preferred: during the procedure, the doctor can not only accurately verify the presence of the problem, but at the same time eliminate it surgically.

Hysterosalpingography is a type of radiologic diagnosis. Before the procedure, the specialist injects a contrast agent into the uterine cavity, which is a water or fat-soluble substance, often including barium or iodine. Hysterosalpingography demonstrates a fairly accurate result - about 75%. The procedure is recommended to be carried out from the 5th to the 9th day of the monthly cycle. The performance of the study has its own peculiarities:

• GSG is not prescribed during an acute inflammatory process or exacerbation of chronic disease of any of the pelvic organs;
• After the procedure, the patient should use protection for one monthly cycle;
• GSG is not performed on pregnant women and those who are allergic to the composition of the contrast agent;
• a few days before the procedure, a woman should not have sexual intercourse, use any vaginal products.

Ultrasound diagnosis (echohysterosalpingography) is performed using an ultrasound scanning device and a special gel substance. In advance, a sterile isotonic sodium chloride solution is injected through the cervix using a catheter, the course of which is recorded on a computer. The procedure is performed after the end of menstruation and before the period of ovulation. It is not necessary to use protection after the examination.

Healthy tubes are not visualized by ultrasound. They can be seen only if there is an accumulation of fluid in their lumen - for example, in the inflammatory process or sactosalpinx. Sactosalpinx on ultrasound can be represented as pyosalpinx and hematosalpinx, since there are no completely reliable ultrasound criteria that characterize the accumulated secretion. That is why the diagnosis should be comprehensive, to give a full assessment of the ongoing pathological process.

Differential diagnosis

Differential diagnosis should be carried out with inflammatory diseases of the female genital system, with adhesions, tumors (benign and malignant), abscesses, endometriosis and so on.

Most often sacctosalpinx has to be differentiated with such pathologic processes:

• Serozocele is a hollow formation with protein-liquid filling, localized in the pelvic region. Otherwise, the pathology is called an inclusion cyst, and its development is associated with adhesions. The clinical picture of serozoeles and sactosalpinx is similar in many respects, so for the differentiation of diseases use the method of magnetic resonance imaging.
• Adenomyosis is a process of uterine endometrial overgrowth, which in the nodular form of the disease is particularly reminiscent of sacrosalpinx. To clarify the diagnosis requires ultrasound, hysteroscopy, MRI.
• Paraovarian cyst is a tumor-like one-chamber cavity formation, which is a smooth capsule with a thin shell. Such a cyst is formed not from the tube or ovary, but from the ligamentous apparatus connecting the uterus to the ovaries. The diagnosis is made on the basis of the results of echoscopy, laparoscopy and transvaginal ultrasound.
• Salpingitis - acute or chronic inflammatory process in the fallopian tubes, which can be determined on the basis of diagnostic results: transvaginal and abdominal ultrasound, hysterosalpingography are performed.
• Adnexitis (salpingoophoritis) is an inflammatory reaction affecting both fallopian tubes and ovaries. It is such a painful process most often becomes the "culprit" of the appearance of adhesions, scars, which can subsequently cause the development of sacctosalpinx. Instrumental diagnostics allows you to easily identify the disease and distinguish it from other symptomatically similar pathologies.
• Endometriosis are processes of endometrioid tissue overgrowth outside the uterine mucosa. To identify this disease, not only vaginal examination and colposcopy, but also ultrasound, hysterosalpingography, and MRI are performed.

Treatment of the sacrosalpinx

In the vast majority of cases, to get rid of sactosalpinx, surgical intervention is prescribed, involving the removal of the affected fallopian tube. Today, such an operation is performed by minimally invasive methods, which allows you to quickly and efficiently perform the procedure, minimizing the period of postoperative recovery.

Some patients manage to achieve a positive result through conservative treatment, but such cases are rare and there are still risks of further ectopic pregnancies. If a woman plans to have children in the future, it is necessary for her to preserve fertility. Therefore, to avoid the risks of tubal pregnancy, doctors recommend a minimally invasive intervention - laparoscopic surgery. Here is what such an operation provides:

• shortens the healing time of postoperative wounds;
• promptly corrects the problem of sacrosalpinx;
• allows you to monitor and adjust the progress of the intervention.

Medications

In a nonsevere course of sacctosalpinx prescribe antibiotic therapy with oral medications for 6-7 days:

• combination of penicillins with beta-lactamase inhibitors (drugs with a broad spectrum of antibacterial activity) - Amoxicillin with clavulanic acid 0.625 g three times a day;
• tetracycline group drugs - Doxycycline 0.1 g twice a day;
• Macrolide antibiotics - Azithromycin 0.5 g twice a day, Roxithromycin 150 mg twice a day, Clarithromycin 0.25 g twice a day;
• fluoroquinolone drugs - Ciprofloxacin 0.5 g twice a day, Ofloxacin 0.8 g once a day for two weeks.

Possible side effects of antibiotic therapy: allergic reactions, dyspepsia, headache, changes in taste sensations.

Nitroimidazole-based preparations are administered orally:

• Metronidazole 0.5 g three times a day;
• Ornidazole 0.5 g three times a day.

Possible side effects: digestive disorders, optic neuropathy, allergies, joint pain, decreased libido.

Oral antifungal treatment:

• Nystatin 500 thousand units 4 times a day;
• Natamycin 0.1 g 4 times a day;
• Fluconazole 150 mg as a single dose.

Side effects: abdominal pain, dyspepsia, increased body temperature.

Oral antihistamine treatment (to prevent the development of allergic processes):

• Fexofenadine 180 mg daily, once daily;
• Chloropyramine in the amount of 25 mg twice a day.

Possible side symptoms: drowsiness, feeling of weakness, tremor, dizziness, irritability.

Additional therapy may be represented by the following medications:

• Nonsteroidal anti-inflammatory drugs with anti-inflammatory and analgesic properties (Paracetamol with Ibuprofen tablet three times a day, rectal suppositories Indomethacin or Diclofenac twice a day for 10-14 days, Naproxen 0.5 g twice a day orally).
• Means based on recombinant interferons, providing immunomodulatory and antiviral activity (interferon alpha or interferon alpha-2-beta 500 thousand units twice a day in the form of suppositories, for ten days).
• Vitamin and mineral complexes (Vitrum, Quadevit, Supradin, etc., for 4 weeks).

In case of severe sacrospinx, antibiotics are prescribed with evaluation of their effectiveness in the first three days. If necessary, the drugs are replaced on the fifth to seventh day. Antibiotic therapy is as follows:

• III or IV generation cephalosporin drugs - Cefotaxime or Ceftriaxone administered 0.5-1 g twice a day intravenously;
• combination of penicillin drugs and beta-lactamase inhibitors - Amoxicillin with clavulanic acid 1.2 g three times a day intravenously;
• fluoroquinolone group drugs (Ciprofloxacin once a day for 1 g, Ofloxacin twice a day intravenously for 0.2 mg);
• aminoglycoside agents - Gentamicin once a day by intravenous 0.24 g, Amikacin 0.5 g by intravenous 0.24 g twice a day;
• lincosamides - Lincomycin 0.6 g w/v three times a day;
• Carbapanema - Imipenem or Meropenem intravenously up to three times a day, 0.5-1 g.

In addition, physiotherapy, phytotherapy, acupuncture, and physical therapy are prescribed. It is recommended to take oral contraceptives (monophasic, medium and low-dose) from the fifth to the 25th day of the monthly cycle for three months to six months.

Longidaza in the treatment of sacrosalpinx

Since sactosalpinx is often a consequence of the formation of adhesions in the fallopian tubes, so to soften them and eliminate the hollow formation, resorbents are often prescribed - in particular, the drug Longidaza. This is a relatively new medication that can successfully eliminate adhesions.

The reproductive organs, bowel and bladder are covered by a smooth connective tissue called the peritoneum. It is the smoothness of this tissue that allows the organs to move freely, relax and contract, and change position during periods, pregnancy, and sexual intercourse. With a healthy unchanged peritoneum internal organs "work" easily and smoothly. If the tissue is damaged by infection, trauma or other irritating factors, then on its surface accumulates fibrin - a protein substance that "masks" the damage and limits the further spread of the problem. Simply put, adhesions form, which over time become thicker and denser, transforming into coarse fibers that limit the normal function of organs.

Adhesions are the first step to the formation of sactosalpinx. It is between them that a kind of "sac" is successfully formed, in which liquid secretion begins to accumulate.

Longidaza suppositories can prevent the development of adhesions and soften the existing adhesions. They are based on hyaluronidase conjugate, an enzyme able to soften pathological connective tissue overgrowths.

The effect of Longidaza in sacrospinx is multifaceted. This drug not only neutralizes adhesions, but also stops the development of inflammation, optimizes blood flow in tissues, prevents the formation of new connective tissue overgrowths. At the same time, Longidaza affects not only new, but also old adhesions.

The treatment regimen for sacrospinx Longidaza is selected individually. Most often, one suppository is administered rectally every other day or once every three days. The course of treatment requires 10-15 suppositories.

The drug is well tolerated by patients. Only in isolated cases local or systemic allergic reactions were noted.

Antibiotic treatment

Sactosalpinx is characterized by a variety of signs, which depends on the degree of lesion and the severity of the inflammatory process. In general, the formed neoplasm and the accumulated secretion in it create favorable conditions for the development and multiplication of infection. Therefore, the inflammatory reaction often develops or worsens, for example, in the post-abortion period, during menstruation, during gynecological and surgical manipulations (insertion of IUDs, hysterosalpingography, hysteroscopy, etc.). To prevent complications, antibacterial therapy is always prescribed for sacctosalpinx. Antibiotics are used, taking into account the sensitivity to them of the pathogen, or prescribe drugs of the most extensive spectrum of action. Dosage and duration of antibiotic therapy are determined individually, depending on the severity of the pathology.

Because of frequent anaerobic infection, adjunctive administration of Metronidazole is recommended. Among antibiotics, cephalosporin drugs and aminoglycosides are considered the most acceptable.

Cephalosporins can be replaced by semi-synthetic penicillins, e.g. Ampicillin. The duration of combined antibiotic therapy is determined depending on the clinical picture and laboratory values, but it should not be shorter than one week.

A special approach to treatment requires pyosalpinx, which has a high risk of perforation into the abdominal cavity. The purulent process can spread, affecting healthy areas of the small pelvis, invading the internal genitalia and other nearby organs.

Antibiotic therapy is used at each stage of treatment, regardless of whether surgical intervention is planned or not. Preoperative preparation for sacctosalpinx includes:

• antibiotics - e.g. Cefoperazone (Cefobid) 2 g per day, Ceftazidime (Fortum) 2-4 g per day, Augmentin 1.2 g intravenous drip 1 time per day, Clindamycin 2 to 4 g per day - with mandatory combination with Gentamicin and Metrogil;
• detoxification treatment - infusion correction of volemic and metabolic disorders;
• laboratory monitoring of treatment dynamics.

Antibiotic therapy must be continued during the surgical phase. It is important to ensure that antibiotics are administered on the operating table immediately after the end of the intervention. The daily concentration of drugs is necessary to create protection against the subsequent spread of the infectious agent.

Postoperative treatment includes the administration of antibiotics against antiprotozoal, antimycotic and uroseptic therapy. Antimicrobial agents are discontinued depending on their toxic load - for example, Gentamicin is discontinued first or replaced with Amikacin.

Treatment of sacctosalpinx with tampons

For several decades now, the so-called "Chinese tampons" have been actively advertised on the Internet, according to the manufacturer, these tampons can cure a woman of almost all gynecological diseases. Here is what the sellers and manufacturers of this product promise:

• repairing a fallopian tube obstruction;
• getting rid of adhesions;
• the ability to conceive naturally.

Needless to say, traditional medicine is, to put it mildly, disapproving of such methods of "treatment". In the best case, the use of such tampons can be simply ineffective, and in the worst case - cause an allergic reaction, aggravation of thrush or mucous membrane burns.

Doctors explain: no one has ever managed to cure sacrospinx by using dubious tampons. And the so-called "cleansing effect" of the Chinese product can be obtained if you spend seven or eight days of treatment with ordinary gauze turundas soaked in aloe juice, sea buckthorn oil, burdock root juice or badanum.

Medics insist: you should not self-medicate and expect a miraculous cure. Hundreds of specialists around the world are working on new effective ways to treat diseases of the reproductive system. And among these new developments there are no famous "Chinese tampons", heavily advertised on the Internet.

If you are in doubt about the use of certain unconventional remedies for sacctosalpinx, the only person who can answer all your questions is your doctor. Consult him and do not look for a "panacea" for all diseases.

Vitamins for sacrospinx.

To reduce the risk of developing sacctosalpinx and prevent complications of this condition, it is recommended:

• regularly visit a gynecologist, endocrinologist, timely treat any functional disorders and diseases;
• to eat rationally and nutritiously, to provide the body with a sufficient amount of micronutrients and vitamins;
• avoid strict mono-diets, which become a stress factor for the female body.

Abrupt reduction of the fat layer can adversely affect the hormonal balance of a woman and lead to a failure of the monthly cycle. And if we take into account the fact that obesity is also not favorable to women's health, weight correction should be carried out smoothly, without disturbances from the hormonal background and reproductive system.

The main vitamins for women are considered to be:

• vitamin _D3;
• tocopherol (vitamin E);
• vitamin A;
• folic acid (vitamin _B9);
• vitamins _B6 and _B12.

Lack of certain vitamins and trace elements in a woman's body can create serious obstacles not only for the successful conception of a baby, but also for the treatment of most gynecological diseases. And in some cases, the correction of vitamin intake into the body plays a crucial role - for example, this applies to vitamin D. And this is not surprising, because vitamin D is characterized by a rather strong influence on the body:

• regulates the production of estrogen and progesterone;
• takes part in the maturation of follicles, ensuring ovulation, formation of the corpus luteum;
• regulates the expression of genes responsible for the implantation mechanism;
• generates a specific immune response aimed at preserving pregnancy;
• normalizes AMH synthesis;
• reduces excessive proliferation of the endometrium, neutralizes hyperandrogenism.

Additional provision of the body with vitamin D occurs with the inclusion in the diet of marine fish, fish oil, egg yolk. In case of diagnosed vitamin deficiency, special pharmacy vitamin preparations are prescribed.

Physiotherapeutic treatment

Physiotherapeutic procedures can be prescribed for recovery after surgery for sactosalpinx, to prepare the uterus before IVF protocol, to accelerate recovery in chronic inflammatory processes, etc.

In addition to indications, there are contraindications:

• malignant tumors (heat exposure is also prohibited in endometriosis and myoma);
• bleeding tendency, systemic hematologic diseases;
• mental problems;
• severe increase in blood pressure;
• decompensated conditions;
• fever, elevated temperature over 37.8°C.

The choice of physical procedure is carried out taking into account the general diagnosis, age, the results of tests for hormones, contraindications, individual characteristics of the body.

The most commonly used hardware treatments are:

• electric or magnetic field (have anti-inflammatory, anti-edematous effect, which is especially important at an early stage of the postoperative period);
• electrotherapy (direct current - galvanization, electrophoresis with medications; pulsed current - interference therapy, electrical stimulation) relieves vascular and muscle spasm, anesthetizes, improves blood supply;
• Ultrasound therapy (anesthetizes, softens adhesions, enhances ovarian hormonal function);
• phototherapy (ultraviolet rays have a bactericidal effect, stop the development of inflammation in endocervicitis, colpitis, etc.).

In gynecological problems, physiotherapy is prescribed to stabilize hemostasis, regulate the monthly cycle, eliminate vegetovascular disorders, eliminate inflammation, get rid of pain, soften adhesions, prevent the development of postoperative complications. As practice shows, the most tangible after physiotherapy are the distant results, so it takes time to assess the effectiveness of procedures.

Treatment in a sanatorium with mud

In the vast majority of cases of sacrospinx, it is recommended to carry out a full course of drug therapy, and if necessary - and surgery. However, sometimes doctors advise alternative options - for example, spa treatment. In special specialized specialized sanatoriums conduct a number of additional studies, determine the initial cause of sacctosalpinx. Most often such causes are chronic inflammatory processes and their consequences. Further, if there are no contraindications, the patient is prescribed a number of therapeutic procedures, including the use of therapeutic mud.

Mud therapy is characterized by quite strong anti-inflammatory, analgesic and sensitizing properties. Baths, mud pools and wraps, massages with mud, vaginal tampons, physical therapy are often recommended as therapeutic procedures for sacrospinx.

Contraindications to mud therapy are considered such diseases and conditions:

• acute stages of inflammatory processes;
• STDs;
• psychopathology, epilepsy;
• acute diseases of the blood and cardiovascular system;
• malignant tumors, hemangiomas;
• a tendency to bleed;
• active tuberculosis, severe thyrotoxicosis;
• renal failure;
• pregnancy, breastfeeding period;
• post-operative period.

In the presence of pyosalpinx, endometriosis, polyps and cysts of the ovary and cervix, mud treatment is also not carried out.

Mud therapy, as well as any other therapy, is carried out with sacrosalpinx with extreme caution. The fact is that the muds at different resorts differ not only in their origin, but also in their chemical composition. Each mud is intended for the treatment of strictly specific pathologies and has a number of indications and contraindications. Given this, you should not go to any mud cure without first consulting a doctor. Moreover, in some cases of sacctosalpinxes, doctors do not recommend this type of treatment at all - it all depends on the results of diagnosis and the course of the disease.

Folk treatment

Folk medicine can offer recipes for almost all diseases, including sactosalpinx. The only condition: such treatment must be approved by the attending physician, otherwise unforeseen complications may arise, including those that can threaten the life of the patient.

Every day before going to bed it is recommended to apply a special compress to the lower abdomen. To do this, boil barley grains until they are ½ cooked, put them in a hot cotton cloth bag and apply them to the abdomen for about half an hour.

Also take in equal quantities of dried leaves of milkwort, mother and stepmother, chamomile flowers, calendula, herb goldenseal, well mixed. Separate 2 tbsp. Of the mixture, brew 500 ml of boiling water, insist for 2 hours, filtered. Drink the infusion of 100 ml 6 times a day half an hour before meals or between meals. Duration of treatment - 4-8 weeks.

During the entire treatment period, one should abstain from sexual activity. If during treatment a woman learns about her pregnancy, the drug is discontinued.

And another effective folk recipe for sacktosalpinx: one cup of dried St. John's wort is steamed in 5 liters of boiling water, insist for an hour and a half, then filtered. Used daily for a sitting bath. Each procedure should last about 20 minutes. The course of therapy - 10-14 days.

Herbal treatment

Bitter mugwort is successfully used for the treatment of sactosalpinx. To prepare a healing infusion, 1 tbsp. Dry plant is placed in a pot and pour cold water (300 ml), kept for 4 hours. Then the pot is put on the fire, bring to a boil and cool down. Filter, drink 100 ml twice a day, for 2-6 months.

Prepare a tincture of prickly pear or winterberry: take 150 g of grass and pour 1500 ml of vodka, put in a dark place. Incubate for about 2 weeks. The resulting remedy is taken 1 tsp. Three times a day.

Prepare a decoction of plantain seed. One tablespoon of seed is poured 250 ml of boiling water and continue boiling for another five minutes. Remove from the fire, cool down. Use 1 tbsp. Three times a day for 14 days. The remedy can be stored in the refrigerator for three days.

A good effect is observed in the treatment of sacrosalpinx with a decoction of gentian rhizome. Take 2 tbsp. Dry crushed root, pour 0.6 liters of boiling water, put on low heat and boiled for ten minutes. Then remove from the fire, cover with a lid and insist for another hour. Take the remedy 100-150 ml three times a day between meals. Duration of therapy - up to three months.

Useful and infusion of ergot: 2 tbsp. Dry plant poured 500 ml of boiling water, insist under a lid for 4-5 hours. Filter, take 4 times a day 100-150 ml half an hour before meals. Duration of treatment - up to 2 months.

A good and affordable remedy is an infusion of sage. One teaspoon of dry raw material is poured 250 ml of boiling water, insist until it cools down. Take the infusion in the morning before breakfast and at night 100 ml for 10 days after the last day of menstruation. In general, the course of treatment is continued for three cycles, after which you should make two cycles of break.

Homeopathy

The possibility of using homeopathy in the treatment of sacrospinx is a controversial issue. Most doctors are inclined to the fact that such drugs can be used only against the background of the main traditional treatment. Despite this, many homeopathic specialists do undertake to restore the health of patients suffering from sactosalpinx, and sometimes - quite successfully. Initially, homeopaths correct the hormonal and neurological state of the patient, prescribing the following remedies:

• Pulsatilla 6;
• Ignatia 6;
• Cimicifuga 6 (exclude taking during menstruation);
• Arnica 3, Sepia 6, Silicea 6 (exclude taking during the full moon period).

The above remedies are taken 5 pellets three times a day. The duration of the treatment course is from six weeks to six months.

Additionally prescribe such drugs:

• Zinc metallic 6 - increases the luteinizing ability of the pituitary gland while attenuating the follicle-stimulating property;
• Cuprum metallicum - activates the ovulation period;
• Borax 6 - favors fertility, especially useful for patients with endometritis.

The dosage of the above remedies is 3 pellets twice a day for a duration of 3 months.

In case of adhesions, Silicea 6, Graphite 6, Calcarea fluorica 6 - 3 pellets of each drug is indicated. Duration of treatment - from 12 weeks to six months.

Surgical treatment

Surgical treatment of sactosalpinx can be radical and reconstructive-plastic. The removal of sacrosalpinx, in turn, can be partial or complete, with the removal of only the affected segment or the entire tube. Reconstructive surgery aims to restore tubal patency, but after such intervention there is a risk of ectopic pregnancy.

Laparoscopy for sacctosalpinx is the most common surgery to help solve this problem. But laparoscopy may not always be used, as there are certain contraindications:

• acute inflammatory processes in the pelvic organs;
• exacerbations of chronic inflammatory processes (less than 5 months before laparoscopy).

Tuboplasty is not performed in patients with a short fallopian tube (less than 4 cm), or when a tubal segment of less than 4 cm in length remains after resection of the sacrosalpinx.

Surgical correction is scheduled for the first phase of the monthly cycle, which allows to provide the most favorable conditions for tissue repair and facilitate rehabilitation. Before the operation, tuboxopia is performed - this is necessary to visualize the endosalpinx, determine the quality of folding, as this plays an important prognostic role. If the mucosal tissue of the tube is in an unsatisfactory state, it makes no sense to try to restore its function: in such a situation, the woman will be recommended IVF procedure.

Laparoscopic intervention - salpingo-ovariolysis - is performed in three accesses (sometimes - in four, in case of severe pelvic adhesions). General anesthesia with sufficient relaxation is used. After correction of the fallopian tube, ovariolysis is performed, with mandatory elevation of the ovary and examination of its surface on the side of the broad uterine ligament (the place of probable location of adhesions).

Tubal removal is performed by salpingectomy and salpingotomy. Salpingectomy is an intervention for unilateral or bilateral tubal removal, which is performed:

• for tubal implantation;
• for chronic salpingitis and sacrospinx.

It is obligatory to remove tubes with sactosalpinx if a woman is planning pregnancy, as well as in case of existence of increased risks of complications of the disease. Often removal acts as a preparatory stage for further IVF.

Prevention

There is no specific prevention of sacrosalpinx. However, there are a number of recommendations, compliance with which allows not only to prevent the development of this disease, but also in general to improve the health of the reproductive system. We are talking about such advice from a doctor:

• it is important to lead a healthy lifestyle, do not smoke, do not drink alcohol, keep physically active, walk, walk in the fresh air;
• You should avoid indiscriminate sexual intercourse - especially without the use of barrier contraception;
• Conceiving a child is an important step that requires careful planning, so it is important to approach the issue responsibly and avoid abortions;
• it's important for any woman to avoid hypothermia;
• It is necessary to eat a high-quality and nutritious healthy diet, watch your weight, and strengthen your immune defense;
• At the first sign of problems with the reproductive organs, you should immediately contact your doctors.

Forecast

If the course of sacrosalpinx is uncomplicated, and the treatment was competent and timely, we can talk about a favorable prognosis of the disease. The danger to health and even to life is the rupture of the sac-like element: in this situation, the prognosis depends on the timeliness and completeness of medical care.

Childbearing function after treatment of sactosalpinx is restored in less than 50% of patients. According to the collected statistical information, the positive result after surgical intervention is observed only in 20-60% of cases. In addition, patients who have undergone sactosalpinx have a significantly increased risk of developing such a problem as tubal ectopic pregnancy.

In order to improve the quality of prognosis and to prevent complications, women are recommended to undergo regular gynecological examinations. This is necessary in order to timely detect and treat pathologies of the reproductive system. It is equally important to take a responsible approach to planning conception, exclude casual sexual relations, do not self-medicate and do not take medications without appropriate indications.