Pain in the appendages
Pain in the appendages is observed in inflammatory and purulent processes in the ovaries and fallopian tubes, cysts, benign, transitional and malignant tumors, ectopic pregnancy, fluid accumulation in the fallopian tubes, ovarian torsion or apoplexy. It can be acute or chronic, constant, periodic, increasing, aching, pulling, pulsating. The cause of the symptom is determined on the basis of complaints, medical history, results of gynecological examination, laboratory and instrumental diagnostic procedures. Treatment – antibiotic therapy, oral contraceptives, vitamins, analgesics, surgical interventions.
Why there is pain in the appendages
Inflammatory processes
Ovarian cysts
Tumors
Ectopic pregnancy
Accumulation of fluid in the fallopian tubes
Purulent processes
Other emergency conditions
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
Why there is pain in the appendages
Inflammatory processes
Inflammation develops against the background of hypothermia, the spread of nonspecific infection from neighboring organs, infection with STIs. It can occur in the form of adnexitis (simultaneous involvement of the ovaries and tubes), oophoritis (ovarian lesion) or salpingitis (pathology of the fallopian tubes). The symptoms are similar in all variants. The difference in clinical manifestations is determined by the form of the disease (acute or chronic).
In acute inflammation, the pain is sharp, intense, radiating to the sacrum and the anus. There are chills, general hyperthermia, intoxication syndrome, dysuria, purulent or mucous discharge. Palpation is sharply painful. With a chronic course during the period of exacerbation, pain is moderately pronounced, dull or aching. Subfebrility, mucopurulent discharge are detected. Menstrual cycle disorders are often observed in patients. When feeling, the soreness is insignificant.
Ovarian cysts
In most cases, ovarian cysts are asymptomatic for a long time. With a significant size, constant aching pains, an increase in circumference and asymmetry of the abdomen are determined. With compression of the intestines and bladder, constipation and dysuria occur. Varicose veins may develop due to compression of the veins. With hormonally active formations, menstrual cycle disorders are observed, sometimes hyperandrogenism, hirsutism. There are the following types of cysts:
paraovarial;
endometrioid;
dermoid;
mucinous.
For corpus luteum cysts and follicular cysts, the symptom is uncharacteristic due to their small size.
Tumors
Pulling, more often unilateral pain in the appendage area is a typical early manifestation of benign ovarian neoplasms. Pain syndrome is not associated with menstruation. Possible flatulence, stool disorders and pollakiuria due to compression of the pelvic organs. Infertility or cycle disorders are detected in 25% of cases.
With feminizing neoplasia in adolescence, early puberty is observed, in reproductive – dysfunctional uterine bleeding, in postmenopausal – spotting. In patients with virilizing tumors, signs of masculinization are determined. The appearance of pain syndrome may be due to the following neoplasms:
Epithelial: light-cell, endometrioid, mucinous, serous, mixed, Brenner’s tumor.
Stromal: fibroma.
Germinogenic: dermoid cyst, teratoma.
Borderline ovarian tumors occupy an intermediate position between benign and malignant. The most common symptom is considered to be pulling dull pain in the appendages and in the navel area, giving to the lumbar region and lower extremities. Possible fatigue, weight loss, loss of performance, hyperthermia, dyspepsia and dysuria.
Localized ovarian cancer, as a rule, is asymptomatic. With the growth of neoplasia, pain, weakness, malaise, increased fatigue, decreased appetite, dysuria, gastrointestinal disorders are revealed. With granulocellular cancer, symptoms of feminization are observed, with androblastoma – signs of masculinization. The occurrence of ascites indicates the involvement of the peritoneum. Neoplasia metastasizes to the bones, lungs, liver.
Pain in the appendages
Pain in the appendages
Ectopic pregnancy
In the absolute majority of cases (97%) tubal pregnancy develops. Ovarian pregnancy is considered a rare phenomenon (1-2%). The formation of ectopic pregnancy is evidenced by the delay of menstruation, pulling painful sensations in the appendages, spotting spotting, nausea, vomiting, loss of appetite, swelling of the mammary glands. Due to the nonspecific nature of the symptoms, patients often regard their condition as the beginning of normal gestation.
When the fallopian tube ruptures, acute sharp pains occur in the lower abdomen, radiating into the anus, lower back and hips. There is a discharge of blood or brownish discharge from the genital tract. Internal bleeding causes a drop in blood pressure, tachycardia, weakness, loss of consciousness. The condition poses a threat to the patient’s life, immediate medical attention is required.
Accumulation of fluid in the fallopian tubes
Hematosalpinx is considered a polyethological pathological condition. In ectopic pregnancy, it precedes the rupture of the tube, it proceeds acutely. With malformations (atresia), it is formed gradually. The severity of the pain syndrome in the appendages increases with each monthly period. Pain is not eliminated by analgesics, with a significant amount of accumulated blood, they persist in the intermenstrual period.
The formation of the hydrosalpinx is preceded by specific or nonspecific inflammation of the appendages, surgery in the pelvic region. Sometimes the pathology is asymptomatic. With clinically significant forms, there are pulsating, bursting or pulling pains, an increase in body temperature, weakness, bruising, abundant watery discharge.
Sactosalpinx develops in inflammatory processes, endometriosis, cancer of the appendages. The acute form is rare, characterized by one- or two-sided pulsating or bursting pain, general intoxication, an increase in temperature to subfebrile or febrile digits. For chronic sactosalpinx, an asymptomatic course is more typical. Pain syndrome is more often bothered when combined with adhesive disease.
Purulent processes
The occurrence of piovar is usually caused by the spread of infection from nearby foci in inflammatory diseases of the appendages, body or cervix. The clinical picture develops acutely, includes intense throbbing pains that increase with defecation, any physical effort. Chills, severe weakness, severe hyperthermia, hectic fever, purulent white spots, dyspeptic and dysuric disorders are detected.
With pyosalpinx, similar manifestations are observed. The combination of purulent lesions of the ovary and fallopian tube can be complicated by the formation of a tubovarial abscess. The pain syndrome is strong, acute, paroxysmal, with an epicenter in the projection of the left or right appendage. Possible irradiation into the rectum, lower back, inner thigh. Pronounced intoxication is detected, the condition is severe. The discharge is yellow-green, yellowish or whitish. Diarrhea, pain during the injection are possible.
Appendicular-genital syndrome is an inflammatory lesion with simultaneous involvement of appendages and appendix. The clinic is determined by the variant of the course. The appendicular form is characterized by manifestations of acute appendicitis, for genital – signs of acute adnexitis. Common symptoms are pain in the appendages and above the womb, dyspepsia, significant hyperthermia. The secondary syndrome is especially severe against the background of pelvioperitonitis.
Other emergency conditions
In patients with ovarian torsion, severe cramping or stabbing pains in the appendage occur suddenly, accompanied by irradiation to the groin, back or side surface of the body. The pains are increasing, supplemented by fever, nausea, vomiting, constipation, palpitation of the heart, pallor of the skin, dysuria. With incomplete twisting, the painful sensations are dull, moderate, and bother periodically.
The twisting of the leg of the ovarian tumor is observed in neoplasia with high mobility: paraovarial and dermoid cysts, fibroids, cysts. With a complete twist, the pain is sharp, paroxysmal. Cold sweat, hyperthermia, tachycardia, hypotension are detected. Patients with incomplete torsion complain of periodic mild or moderate soreness.
A mild degree of ovarian apoplexy is manifested by short-term pain and nausea. With an average degree of pain in the projection of the appendage, intense, weakness, indistinct peritoneal symptoms are noted. Severe degree is characterized by very strong persistent pain, bloating, collaptoid state, shock, bright signs of irritation of the peritoneum.
Diagnostics
Diagnostic measures are carried out by a gynecologist. During the survey, the specialist finds out when and under what circumstances pain appeared in the appendages, how the symptom changed over time, what other manifestations it was accompanied by. As part of a physical examination, the doctor assesses the general condition, reveals hyperthermia, tachycardia, decreased blood pressure, shock phenomena, positive peritoneal symptoms. The examination program includes diagnostic measures such as:
Gynecological examination. It allows you to detect pathological secretions, the presence of bulky formations, soreness during palpation. With purulent processes, bimanual examination may be difficult due to severe pain syndrome. When fluid accumulates in the fallopian tubes, palpation is carried out with caution to avoid rupture of the tube.
Puncture of the posterior vaginal arch. The method makes it possible to obtain fluid (serosa, blood, pus) from the pelvic cavity. It is indicated for suspected ectopic pregnancy, cyst rupture, inflammation of appendages. It is a screening study for cancer, confirms the presence of a malignant tumor by detecting atypical cells during cytological examination.
Ultrasonography. Transabdominal or transvaginal ultrasound of the pelvis is considered a safe and informative technique used to detect cysts, neoplasia, purulent and inflammatory processes, expansion of the fallopian tubes due to fluid accumulation. Patients with malignant and borderline tumors undergo ultrasound of the abdominal cavity to detect peritoneal dissemination, liver and spleen metastases.
CT of pelvic organs. The study is recommended for purulent diseases of the appendages, is performed at the final stage of the examination, helps to confirm the diagnosis with almost 100% probability and determine the prevalence of the process. A rounded or oval formation with fuzzy contours and an inhomogeneous structure is visualized, covering the tube, ovary or both organs. In cysts and tumors, CT is indicated to clarify the size, location and structure of the formation, relationships with surrounding tissues.
Diagnostic laparoscopy. It is carried out with cysts, ectopic pregnancy, ovarian torsion, and other pathologies. Provides direct visualization of appendages and nearby structures, which helps to accurately determine the nature of the disease and perform differential diagnosis. Biopsy sampling and therapeutic measures are possible.
Laboratory tests. In inflammatory diseases, emergency conditions, a general blood test is prescribed to assess the severity of the inflammatory process, the severity of blood loss. With volumetric formations, immunochemical tests are performed to determine the level of cancer markers. Punctates and biopsies are studied during cytological or histological examination.
Consultation of a gynecologist
Consultation of a gynecologist
Treatment
Conservative therapy
The treatment regimen is made taking into account the nature of the lesion of the appendages. In purulent, inflammatory diseases, antibiotic therapy occupies a central place. Initially, broad-spectrum drugs are used, then the prescriptions are adjusted taking into account the sensitivity of the pathogen. Drug therapy also includes painkillers, anti-inflammatory and desensitizing agents.
With ovarian cysts, conservative management is possible in the absence of complications. Two-phase or monophasic oral contraceptives, vitamin complexes, exercise therapy, balneotherapy, acupuncture are recommended. Patients with borderline or malignant neoplasms may be shown chemotherapy and radiation therapy.
Surgical treatment
Depending on the cause of the pain , the following operations are performed:
Volumetric formations: open or laparoscopic removal of a cyst, wedge-shaped resection of the ovary, unilateral or bilateral oophorectomy or adnexectomy, extirpation of the uterus with appendages, resection of the large omentum.
Ectopic pregnancy: laparoscopic tubotomy or tubectomy, with significant blood loss – laparotomic removal of the fallopian tube.
Purulent processes: drainage, washing through the vagina, rectum or anterior abdominal wall, excision of an inflammatory conglomerate, in severe cases – pangisterectomy.
Other emergency conditions: appendage detorsion, excision of the tumor when the leg is twisted, surgical removal of the ovary or appendage.
