Serosocele

When doctors detect the accumulation of serous fluid in any of the body cavities or under the skin, they speak of serosocele. This neoplasm can be localized in any area of the small pelvis and is most often caused by a surgical operation, an acute inflammatory process, endometriosis, peritonitis, etc. Another possible name for serosocele is an inclusive cyst.

Epidemiology

Serosocele is a fairly common pathology that can occur at almost any age. However, most often the problem is diagnosed in women 30-45 years old.

The moisture accumulating in the tissues is transparent and has a light yellow tint. With complications, pus or blood may be found in the composition of the fluid.

Serosocele rarely poses a threat to the patient's life: this disease is not prone to malignant transformation, and timely treatment helps to completely get rid of the pathology without any negative consequences.

Causes serosocele

Serosocele is often diagnosed in female patients, shortly before menopause. However, there are other reasons for the development of pathology:

• Inflammatory processes affecting organs located in the small pelvis (salpingo-oophoritis, endometritis, peritonitis, parametritis, prolonged presence of the IUD, repeated abortions and curettage, sexually transmitted infections - all these factors cause fibrinous "adhesion" of tissues, the formation of adhesions and accumulation liquid in the interfusion space).
• Surgical interventions on the pelvic organs and abdominal cavity (extirpation of the uterus, appendectomy, etc.).
• Injuries to the abdominal organs, intra-abdominal bleeding.
• Endometriosis

The accumulation of fluid can provoke even a simple surgical intervention. But most often the problem develops after the removal or structural change of organs.

Often, serosocele is found after such operations:

• contour plastic surgery (braces, liposuction, etc.);
• breast augmentation surgery, mastectomy;
• hernia repair;
• abdominal plastic.

Risk factors

There are many factors known to predict the risk of serosocele.

• Heredity plays a significant role. The risk of the disease increases if tumor genital or extragenital processes have been diagnosed in close relatives.
• Patients with a history of serosocele often have chronic tonsillitis, childhood infectious pathologies (scarlet fever, measles). It has been proven that toxic infections negatively affect the genitourinary system, reducing the body's resistance to various pathologies, and creating favorable conditions for the appearance of metabolic disorders.
• Patients with serosocele are often diagnosed with extragenital pathologies - for example, diseases of the cardiovascular system (more than 17%), the endocrine system (about 16%), the digestive tract (about 14%), and the hepatobiliary sphere (more than 14%). [1]
• Patients with serosocele often have a history of prolonged infertility, spontaneous abortions, and medical abortions.

Surgical interventions that can give an impetus to the formation of serosocele include appendectomy, cesarean section, uterine extirpation, bowel or ovarian surgery.

Pathogenesis

Serosocele is a benign neoplasm located in the pelvic area. In such a formation, moisture accumulates without signs of an inflammatory process.

The cyst can have different sizes, depending on the amount of fluid in it - from a few millimeters to several centimeters.

Serosocele is called an inclusion cyst. The neoplasm has a spherical, oval or irregular configuration, it can have one or more chambers. Adhesions formed as a result of inflammation or surgery become walls, membranes or partitions.

The cavity formation is filled with a light yellow liquid: usually its volume ranges from ten milliliters to a liter.

Serosocele can form in any cavity affected by adhesive changes. However, most often the problem is found in the area of the uterus and appendages.

Symptoms serosocele

Serosocele is detected mainly by chance, since the symptoms of the disease are nonspecific. Even after listening carefully to the patient's complaints, it is almost impossible to immediately diagnose serosocele. Pathology in the overwhelming majority of cases is asymptomatic, and sometimes manifests itself as CPP syndrome - chronic pelvic pain. The patient may complain of lumbar and spinal pains, pulling sensations in the lower abdomen. The pain tends to intensify as a result of hypothermia, physical exertion, stress. Women often have violations of the monthly cycle, painful PMS, etc. Not uncommon - unpleasant and even painful sensations during sexual contact. The pain can be quite pronounced: some women are forced to give up sex because of this.

Regular painful sensations gradually "exhaust" the nervous system, negatively affect performance and immunity. In some cases, reproductive ability also suffers: often women with serosocele seek medical help because they cannot become pregnant.

The first signs of serosocele often go unnoticed, so the pathology is referred to as difficult to diagnose. Only when performing a planned ultrasound can the presence of a pathological formation be considered. Palpation can determine the problem only when it reaches a significant size, exceeding 15-20 centimeters.

Stages

Symptoms for serosocele often depend on the size and location of the neoplasm, as well as on the stage of the pathological process.

• The acute stage is rare: patients complain of dyspepsia, fever, tachycardia. The abdomen is painful on palpation.
• The intermittent stage is manifested by recurrent pain and / or bowel and menstrual disorders.
• The chronic stage occurs most often. It is characterized by latent symptoms, rare pulling pains, infertility.

Forms

Neoplasms are classified depending on the cause, localization of the process, as well as its size.

The main factor in the formation of serosocele is the adhesive process, which occurs for various reasons. It is between the adhesions that a cystic formation with a liquid content develops, which disrupts the work of internal organs, intestines, etc.

Serosocele in the small pelvis after surgery often appears when adhesion formation was not prevented during the rehabilitation period. Pathology can form after an ectopic pregnancy, cesarean section, appendectomy, etc.[2]

Ovarian serosocele is often the result of inflammatory processes - adnexitis, salpingo-oophoritis. At the site of a prolonged inflammatory process, adhesions are formed, which become a kind of framework on which the cystic formation is subsequently built. In some cases, the problem develops after the removal of ovarian cysts.

Serosocele of the uterus can be the result of parametritis, endometritis, pelivioperitonitis, or due to the use of an intrauterine device for a long time, curettage, multiple artificial abortions, infection of the reproductive organs. In the course of the inflammatory process, fibrin accumulates on the peritoneal surface, and closely spaced tissues stick together. As a result, the adhesion process develops, and in the formed inter-adhesion space, serous contents accumulate - this is a pathological neoplasm.[3]

For the appointment of the correct treatment, it does not matter whether serosocele is found on the left or on the right. The degree and intensity of cyst growth, the presence of symptoms, and also how much the tumor interferes with the function of other organs of the small pelvis is important.

Since the right ovary is located in the immediate vicinity of the appendix (it is also a vermiform appendix), with appendicitis, inflammation can easily spread to the ovary, which subsequently will cause the appearance of serosocele on the right. In some cases, doctors have to differentiate the symptoms of appendicitis from the signs of cystic formation of the right ovary.[4]

If a serosocele with a parietal element is found, then in order to exclude a malignant process, a study for the CA-125 tumor marker is mandatory. [5]

Often, along with serosocele, an accumulation of fluid is found in the posterior space - more than 50 ml. In such a situation, a woman should be carefully examined. In particular, the fluid can be the result of a cyst leakage, or its so-called opening. A small volume of liquid (up to 50 ml) without additional inclusions (for example, blood) is considered a normal variant.

Complications and consequences

Despite the seeming harmlessness of serosocele, this disease can lead to serious complications, including bending of the uterine cervix, disorder of the menstrual cycle, ectopic pregnancy, etc. This is because the neoplasm can contribute to the displacement of the pelvic organs and disrupt their performance. [6]

Serosocele is a kind of abdominal cyst - it is a serous fluid that accumulates between adhesions. After a puncture or even after removal of the cyst with the help of surgery, the same neoplasm may form at the site of the adhesions.

Can serosocele disappear? This scenario is also possible. For example, when adhesions are softened, the contents of the cyst can spill out. At the same time, its walls fall and it actually disappears from the field of view of the ultrasound monitors. However, according to statistics, the "disappeared" cyst has a high chance of reappearing - this happens in about half of the cases.

Can a serosocele burst? Rupture of the neoplasm is unlikely, but such an outcome cannot be completely ruled out. Usually, the cyst is regularly monitored and, in case of its critical increase, the patient is referred for surgery. Serosocele of small size, as a rule, cannot burst. But medical monitoring of tumor growth should become mandatory.

Diagnostics serosocele

The following diagnostic measures are considered mandatory:

• laboratory tests (general blood test with determination of total protein, creatinine and urea, bilirubin, liver enzymes, blood sugar; serological blood test with Wasserman reaction, determination of Rh factor, HbSAg; general urine test, assessment CA-125);
• instrumental diagnostics (vaginal and rectovaginal examination, diagnostic uterine curettage with histological examination, ultrasound of the pelvic organs and abdominal cavity, chest x-ray, fibrogastroduodenoscopy, colonoscopy to exclude metastatic lesions of the appendages, CT and / or MRI of the abdominal organs).

For patients under the age of 30, β-chorionic gonadotropin and α-fetoprotein are determined.

The basic diagnostic method for serosocele is ultrasound. The disease is indicated by the proliferation of the peritoneal mesothelium, which is clearly seen with transabdominal ultrasound and MRI of the pelvis.

Differential diagnosis

Differential diagnosis of serosocele is usually carried out with the following painful processes:

• paraovarian cystic formation;
• hydrosalpinx (fluid accumulation in the uterine tube);
• pyosalpinx (purulent accumulation in the uterine tube);
• cyst of the appendix (mucocele).

If septa are found in the neoplasm, then serosocele should be distinguished from chamber peritoneal mesothelioma and malignant process in the ovaries.

If there is the slightest suspicion of oncopathology, it is imperative to perform a biopsy of the formation.

Treatment serosocele

In the absence of symptoms and complaints from the patient, there is no need to rush to treat serosocele: the doctor prescribes regular examination and ultrasound to monitor the dynamics of the neoplasm every 6 months. If serosocele is diagnosed in a pregnant woman, then there are considerable risks of impaired blood circulation in the fetus, therefore ultrasound is performed 1-2 times a month.

If the patient indicates a severe pain syndrome, then the only radical solution to the problem is surgery. [7]Physiotherapy can be prescribed as a supplement.

Medication usually includes anti-inflammatory, anti-adhesion (resorbable) and hormonal agents.

Serosocele and IVF

Pregnancy and serosocele is not a very desirable combination from a medical point of view, which requires a particularly careful approach from a gynecologist. A large neoplasm can provoke compression of nearby organs, a violation of the blood supply to the reproductive system. A large cyst can cause severe pain, and compression of the enlarged uterus can lead to the development of complications during gestation. It is optimal to remove serosocele even before pregnancy, so no specialist will dare to prepare a patient for IVF against the background of this pathology.

Serosocele only minor in size are not considered a contraindication to IVF. However, the decision in any case remains with the treating doctor.

How to stop the growth of serosocele?

In order to stop the growth of serosocele, it is possible to use enzyme agents based on hyaluronidase. This enzymatic substance affects the "skeleton" of the connective tissue fibers, of which the adhesions that form the neoplasm are composed. It makes no sense to introduce natural hyaluronidase into the body: it is quickly neutralized by blood plasma components and does not have time to complete its therapeutic task. Therefore, Longidase is used for treatment - we are talking about a modern enzyme agent based on the action of the same hyaluronidase. However, unlike the absorbable medicines of previous generations, in Longidaz, the composition is balanced by a high-molecular-weight representative. This allows hyaluronidase to show resistance to outside enzymatic influences and demonstrate its therapeutic effect. Longidase optimizes the redistribution of moisture in the intercellular space, which, in turn, helps to eliminate edema, resorption of hemorrhages, and also improves the percentage of antibiotics directly to the infectious focus. In addition, a decrease in the density of the connective tissue base under the influence of Longidase increases the elasticity of adhesions, which helps to reduce pain.

Serosocele development often goes unnoticed by the patient. First, adhesions are formed, which act as a retaining "skeleton" for the neoplasm. In this situation, it is important both to eliminate the existing adhesive process and to prevent the appearance of new pathological elements. Longidase will also help with this, which will reduce the swelling of inflamed tissues, make the formed adhesions more elastic and prevent the formation of new ones.

Longidase is available in the form of suppositories and a lyophilisate for the preparation of an injection solution. The doctor will be able to choose the correct therapy regimen and describe in detail the main points of the treatment with an enzyme preparation.

Medicines that a doctor may prescribe

Treatment of serosocele currently involves the appointment of anti-inflammatory and antibacterial drugs. However, even long-term use of antibiotic therapy does not always provide sufficient concentration and supply of medications to the focus of a chronic inflammatory process. Doctors have been using proteolytic enzymes for many years in a row - their ability to enhance the therapeutic effect of antibiotics, improve their penetration into tissues and increase the effectiveness of treatment has been proven by a number of tests and clinical trials.

One of the main factors in the formation of disorders of the connective tissue is the inflammatory process. Of course, in order to get rid of serosocele, it is necessary to comprehensively influence both the formed fibrous process and the inflammatory reaction that activates its formation.

For serosocele, your doctor may prescribe the following medications:

Aloe extract liquid	Biogenic stimulant, which is injected subcutaneously, 2 ml daily for ten days. Side symptoms are rare: allergic reactions, sensations of blood rush to the pelvic area, increased monthly bleeding are possible.
Folic acid	A drug that takes part in many important biochemical processes. It is taken 1 capsule (2 mg) three times a day for a month. Usually the drug is well tolerated, only in rare cases nausea, itching, insomnia can disturb.
Vitamin E	Fat-soluble vitamin with pronounced antioxidant and radioprotective properties. Take 0.4 g twice a day. The duration of admission is determined by the doctor. Possible side effects: allergic reactions, dizziness, nausea, general weakness.
Longidaza	Is the "gold standard" treatment for serosocele. Suppositories are prescribed rectally or vaginally 1 pc. Once a day at night, for 10-20 days. If necessary, repeat the treatment after 3 months. When using for the first time, it is necessary to take into account the possibility of individual hypersensitivity to the drug. The treatment regimen by the injection method of Longidase is determined by the doctor individually.
Trypsin	A proteolytic agent that can be administered by intramuscular injection or electrophoresis. Intramuscularly inject 0.01 g of the drug 1-2 times a day, with sodium chloride or procaine. The treatment course usually includes 10-15 injections. Possible side effects: allergies, tachycardia, pain at the injection site.

Vitamins

If serosocele is found already with a sufficiently large size, there is an active adhesion process, then in addition to the main treatment, biogenic stimulants and absorbable drugs are prescribed, such as aloe, FiBS, vitreous body, Lidaza, Longidaza, Gumisol.

In addition to all of the above, injections of vitamin B ₁₂, or cyanocobalamin, are prescribed, at 400-600 mcg per day, for two weeks. In addition, thiamine chloride, or vitamin B ₁, is shown, 0.5-1 ml of a 2.5% solution for a month.

Cyanocobalamin allows you to eliminate pain syndrome, restore metabolism in tissues. And thiamine chloride regulates metabolism, takes part in the processes of nervous excitation. These vitamins help to restore the affected tissues, accelerate recovery and prevent the development of recurrence of serosocele.

Physiotherapy treatment

Physiotherapeutic methods often become auxiliary in a complex of therapeutic measures, consisting of drug and surgical treatment. Physiotherapy helps:

• reduce the duration of therapy;
• prevent the development of complications and relapses;
• prevent the development of side effects from drug therapy;
• reduce the drug load on the body.

With serosocele, the following procedures are most often prescribed:

• Electro and magnetic therapy - often used in the early postoperative period, have anti-inflammatory and decongestant effects.
• Ultrasound therapy - provides an analgesic effect, helps to soften adhesions, and optimizes blood circulation.
• Phototherapy - causes a powerful bactericidal effect, helps to stop the inflammatory process.
• Manual therapy, massage - affects the skin receptors, the vasculature of the internal organs, noticeably improves blood and lymph circulation in the pelvic region and the entire abdominal cavity.

Treatment for serosocele requires a careful and individual approach. Physiotherapy can become exactly the very necessary link in the chain of therapeutic measures that contribute to the improvement of the general state of health and, in particular, the reproductive function of patients.

Alternative treatment

Sometimes patients try alternative treatments for treatment. However, medical specialists are skeptical about this type of therapy and consider it ineffective, allowing only a combination of non-traditional treatment and the prescription of the attending doctor. For example, with serosocele, it is popular to use a decoction of bergenia rhizome. For its preparation, take 15 g of crushed raw materials, pour 200 ml of boiling water, incubate for about half an hour in a water bath, filter and squeeze, add water to 200 ml. The remedy is drunk on an empty stomach for 2 tbsp. L. Three times a day, or used for douching.

Another common recipe is to use the infusion of marin root three times a day before meals, ¼ cup (about 50 ml) for a month. To prepare the infusion 1 tsp. Raw materials are poured into 400 ml of boiling water, left overnight under a lid. The next morning they filter and take. Store in the refrigerator.

Another recipe involves the use of the herb morinda lemongrass. For treatment, the juice or powder (crushed raw materials) of the plant is usually used.

To get rid of serosocele, some patients resort to hirudotherapy: procedures with the setting of medical leeches are repeated 2-3 times a year.

Herbal treatment

Herbal treatments are usually available and sometimes effective. However, such an unconventional approach to solving the problem must be discussed in advance with your doctor. Various medicinal plants can be used for serosocele by adhering to the following recipes:

• Juice is squeezed out of fresh burdock leaves. Take 2 tbsp. L. Three times a day, about half an hour before the main meal. The duration of treatment is 1 month.
• Take 4 tbsp. L. Dried acacia flowers, pour 0.5 liters of vodka, place in a dark place for 7 days. After a week, the tincture is filtered, take 1 tbsp. L. Three times a day before meals.
• Pour 1 tbsp. L. Clover 1500 ml of boiling water, infused for 7-8 hours. Filter and drink the entire volume throughout the day. The procedure is repeated daily for 8 weeks.
• Take 5 tbsp. L. Fresh spruce needles, pour 1 liter of boiling water, insist in a thermos for 24 hours. Take in the morning before breakfast, 3 tbsp. L. Of this product, before lunch - 100 ml, and before dinner - 50 ml. The scheme of admission is as follows: 3 days are taken, 2 days are a break. The total duration of treatment is 5 weeks.

Homeopathy

Unconventional treatments such as homeopathy cannot replace surgery. However, in mild cases, doctors allow the use of homeopathic medicines that act mildly, do not have negative side effects.

The selection of a suitable remedy is made only with the use of an individual approach, a detailed collection of anamnesis. Each case for a homeopath is not only a particular course of the disease, but also the individual characteristics of the patient. Only taking into account all the nuances can one hope for the healing of a person with serosocele.

For serosocele, drugs such as Angustura vera, Bellis perennis, Calcarea fluorica, Kuprum metallicum, Nux vomica, Ignatia amara are recommended for prescription. Arnica montana, Hypericum perforatum, Aconitum napellus, Calcarea carbonica, Phosphorus have a good effect.

The main appointments can be:

• Silicea 6 - within 3 weeks, C12 or C30;
• Apis melifica 6;
• Silicea 30 combined with Apis melifica 6.

Surgery

Quite often, getting rid of serosocele becomes impossible without radical surgical treatment. Usually, adhesions are dissected using the laparoscopic or laparotomy technique. Unlike puncture, the risk of serosocele recurrence after surgery is only about 30%. In the postoperative period, the patient is prescribed rehabilitation treatment, with the use of absorbable drugs, physiotherapy, exercise therapy.

The adhesions holding the serosocele are dissected with a scalpel, laser beam, "electro-knife" or by means of aquadissection. After the procedure, it is possible to apply resorbable polymer materials to the tissues, preventing the recurrence of the adhesions.

Laparoscopy has several advantages over laparotomy:

• less postoperative discomfort;
• fast rehabilitation period, early discharge of the patient;
• the best cosmetic result (almost complete absence of postoperative scars).
• However, laparoscopy also has some disadvantages, for example:
• some technical difficulties, the need for special equipment;
• the need for appropriate training of specialists.

In normal cases, doctors prefer laparoscopy. If the serosocele has a pronounced size, is accompanied by an extensive adhesive process, then the choice may end in favor of a laparotomy.

Recovery after surgery can last from 2 months to six months, depending on the scale of the operation. Throughout the entire rehabilitation term, the patient is regularly subjected to control ultrasound. During rehabilitation, it is recommended to refrain from physical exertion and thermal procedures, eat full and high quality, monitor normal bowel movements, and control your own weight.[8]

The operation to remove the serosocele usually ends positively: the cyst disappears along with all the previously disturbing symptoms. Potential complications of surgical treatment include:

• infectious processes;
• postoperative hernia;
• damage to the intestines, bladder;
• intestinal obstruction.

Complications after laparoscopy occur quite rarely, but with laparotomy this happens more often - about 4 times.

Puncture of serosocele

A puncture biopsy is considered the minimum surgical operation for serosocele. The procedure is performed as follows. Under ultrasound supervision (monitoring), the surgeon inserts a special needle into the cystic cavity and sucks out the fluid present in it. Directly during this procedure, the pressure that the neoplasm exerts on the surrounding tissues and organs decreases, and pain disappears. If fluid accumulates again, the puncture is repeated.

The pumped-out liquid is subjected to laboratory analysis. With the help of enzyme immunoassay and bacterial cultures, the microbial flora is identified, its sensitivity to antibiotic therapy is determined. In the course of the study, it is possible to determine the belonging of bacteria, viruses, fungal infection, to identify a chronic urogenital infection and antibodies to the causative agent of tuberculosis. Diagnostic results directly affect the schedule of medical appointments.[9]

Prevention

To date, no cases of transformation of serosocele into a malignant process have been recorded. However, this disease can cause a number of complications. Therefore, it is important to follow the prophylactic prescriptions of doctors in order to prevent both the appearance and recurrence of serosocele. Experts recommend:

• annually undergo a preventive examination by a gynecologist;
• prevent and promptly treat endometriosis, inflammatory processes in the small pelvis;
• to use effective contraceptives to prevent unwanted pregnancy;
• during pregnancy, strive for natural vaginal delivery.

Serosocele is classified as a peritoneal cyst with a difficult diagnosis. This is due, in particular, to the difficult clinical differentiation of the disease. And this is another reason why it is necessary to pay enough attention to the prevention of pathology.

Forecast

The prognosis for the detection of serosocele depends on several factors at once - for example, on the size of the pathology, on its localization, on the age and general health of the patient. An unfavorable development of events can be talked about in the absence of therapy and supervision by a doctor.

In order to improve the prognosis, it is recommended to lead a moderately active lifestyle, avoid overload and carry weights, and give up strength training. However, complete lack of physical activity is also discouraged.

It is equally important to monitor the diet, to prevent excess weight.

Any diseases of an infectious and inflammatory nature should be treated as soon as possible. It is necessary to prevent STI infection, to refrain from unprotected sex. With serosocele, it is imperative to regularly visit a doctor for control diagnostics.