Adnexitis (salpingoophoritis) is an inflammatory disease of the uterine appendages (fallopian tubes and ovaries), the causative agent of which can be gonococcus, streptococcus, enterococcus, staphylococcus, chlamydia, mycoplasma, ureaplasma. Adnexitis leads to the formation of adhesions in the fallopian tubes, which can cause infertility or ectopic pregnancy.
Most often, the infection enters the appendages of the uterus from the vagina. Also, the pathogen can be transferred from other organs through lymphatic and blood vessels. The danger of inflammation of the appendages lies in the fact that, having a sufficiently erased beginning, which a woman may not notice, the disease takes a severe form, leading to infertility. Adnexitis most often occurs after childbirth, abortions, the introduction of an IUD (intrauterine device), because at this time the appendages of the uterus are more vulnerable.
Depending on the clinical picture, acute and chronic adnexitis are distinguished. With acute adnexitis, the patient experiences pain in the lower abdomen, deterioration of general well-being, the temperature rises to 38-38.5 degrees. In particularly severe cases, pus accumulates in the fallopian tubes and ovaries. The consequence of acute or subacute inflammation of the appendages of the uterus is the adhesive process in the pelvis between the tube, ovary, uterus, pelvic wall, bladder, omentum and intestinal loops. If acute or subacute adnexitis is not treated, it turns into a chronic form.
With chronic adnexitis, the course of the disease is less pronounced. A woman is worried about dull, aching pains in the lower abdomen, giving to the lower back, menstrual cycle disorders, vaginal discharge, decreased sexual desire. Sexual intercourse causes pain due to inflammatory processes in the appendages of the uterus. Chronic adnexitis is characterized by periodic exacerbations, which are caused by hypothermia, fatigue, stress, menstruation.
Chronic adnexitis can lead to the formation of adhesions in the pelvis and hydrosalpinxes. In addition, with a prolonged course of adnexitis, usually more than 2-3 years, various neuro-endocrine disorders may occur, manifested by neurosis (a woman is excitable, irritable; gets tired quickly), obesity or sudden weight loss, disorder of the functions of the endocrine glands, in particular the ovaries.
DIAGNOSIS OF ANDEXITIS
Diagnosis of adnexitis begins with an examination by a gynecologist. Ultrasound is also performed, in which enlarged fallopian tubes and free fluid in the pelvis (inflammatory exudate) are visualized. In addition, swabs are taken from the vagina and the cervical canal, which make it possible to determine the causative agent of the disease. In some cases, the material for microbiological examination is obtained by puncture of the uterine appendages through the posterior vaginal arch under the control of ultrasound. A general blood test is also prescribed, the changed parameters of which indicate an inflammatory process in the body (for example, leukocytosis, increased ESR). If the infection also affects the urethra and bladder, a general urine test is performed.
Laparoscopy is the most accurate method of diagnosing both acute and chronic adnexitis. With the help of an endoscope inserted through small incisions in the abdomen, the surgeon examines the pelvic organs, determining the nature of the inflammatory process. During the operation, pus is removed and medications are administered. Microbiological examination of the contents of the fallopian tubes and abdominal cavity taken during laparoscopy allows the most accurate determination of the causative agent of the disease.
Treatment. In the subacute stage, they carefully proceed to physiotherapy procedures, which are prescribed for chronic salpingoophoritis (dirt, ultrasound, diathermy, etc.). Early initiation of treatment prevents the formation of scarring changes in the appendages of the uterus and the occurrence of persistent infertility. Purulent salpingoophoritis requires surgical treatment, tuberculous salpingoophoritis requires the use of anti—tuberculosis drugs.
Treatment of acute adnexitis. Severe forms of acute inflammation of the appendages should be treated only in a hospital. Broad-spectrum antibiotics are prescribed in the form of intramuscular or intravenous injections, medications that inhibit the growth of anaerobes are prescribed. To relieve the symptoms of general intoxication, intravenous drip of solutions and vitamins are used.
In the case of peritonitis or the formation of purulent sacs in the fallopian tubes, surgical treatment is performed. Now laparoscopic operations are practiced in medicine, in which the necessary amount of intervention is performed through a 2-3-centimeter incision on the anterior abdominal wall with the help of a special device — a laparoscope. Immunomodulators are also used. When providing first aid, it is possible to use cold on the suprapubic area. In this case, heating is contraindicated, you can not use a heating pad.
Treatment of chronic adnexitis. In case of exacerbations, it is possible and desirable to prescribe a course of antibiotics, which is accompanied by the appointment of drugs with an immunomodulatory effect. It is necessary to take multivitamins, restoratives, drugs with an anti-allergic effect. Analgesics, acupuncture, psychotherapy, acupressure are prescribed. During periods of remission, resorption therapy (mud swabs, candles, ultrasound, magnetic therapy, electrophoresis of iodine, zinc, copper) and physiotherapy. Spa treatment also has a positive effect on patients. Currently, in the treatment of chronic adnexitis, hormonal contraceptives are used to prolong the remission period, they are prescribed for 6-8 months, and sometimes for a longer period. With a pronounced pain component, extensive scar-adhesive process in the pelvis and the formation of fluid sacs (hydro- and pyosalpinxes) in the appendages, surgical treatment is indicated. Dissection and removal of adhesions, restoration of patency of the fallopian tubes, removal of purulent and fluid formations that appeared as a result of the transferred inflammation are performed. Restoration of patency of the fallopian tubes does not mean normalization of their function, the risk of infertility with a pronounced adhesive process in the pelvis remains high even after a successful operation.
Prevention of salpingoophoritis is aimed at preventing the possibility of introducing infectious agents during childbirth and abortions. Prevention of gonorrheal and tuberculous salpingoophoritis is carried out according to the general rules for combating these diseases.
