Piosalpinx
Pyosalpinx is a disease of the female reproductive system caused by the accumulation of pus in the lumen of the fallopian tube. This pathology is often a consequence of the inflammatory process occurring in the body — salpingitis. At the same time, the walls of the fallopian tube thicken, become edematous, which violates its patency, a closed cavity filled with purulent contents is formed. The affected part of the fallopian tube tends to fuse with neighboring organs: the ovary, omentum, intestinal loops, forming a single inflammatory conglomerate. Not only the ovary can participate in the inflammatory process. In this case, there is a high risk of damage to the peritoneum and intestinal loops, the formation of an abscess. When the wall of the pyosalpinx ruptures, pus can enter the bladder, rectum, vagina, forming fistulas. Sometimes the breakthrough of the abscess is directed into the free abdominal cavity, in this situation diffuse peritonitis develops. In the first months, the pus in the pyosalpinx is liquid, but over time it becomes thick.
The content of the article:
Causes of the appearance and development of pyosalpinx
Symptoms of pyosalpinx
Diagnosis of pyosalpinx
Possible complications
Treatment of pyosalpinx
Prevention of pyosalpinx
Piosalpinx
Causes of the appearance and development of pyosalpinx
The cause of pyosalpinx is the ingress of infectious pathogens into the fallopian tubes with the subsequent development of septic inflammation in them. Most often, when examining a patient, chlamydia, staphylococci, streptococci, enterococci are detected, which can form microbial associations or provoke disorders in isolation. The ways of infection penetration into the body are divided into:
Ascending: from the vagina to the uterus and further into the appendages with incurable gonorrhea, chlamydia and trichomonasis transmitted as a result of promiscuous sexual relations. The most severe is pyosalpinx, caused by staphylococcus. Less vivid and more protracted nature of the disease is provoked by gonococci, chlamydia, mycoplasma;
Lymphogenic: penetration is carried out through the lymphatic vessels in tuberculosis or intestinal infection;
Hematogenic: infection penetrates through the blood if there is a focus of inflammation in the body;
Contact: occurs during surgical interventions, abortions, illiterate curettage, spontaneous termination of pregnancy. More often, the development of pyosalpinx is due to the consequences of abortion, less often the cause lies in postpartum infection.
With the weakening of the immune system, the body is unable to cope with the pathogen and the development of pyosalpinx occurs. The progression of the disease is influenced by the following factors: early onset of sexual activity, promiscuous change of partners, sexual intercourse during menstruation, the use of intrauterine contraceptives, uterine prolapse.
According to the nature of the manifestation of the pyosalpinx , there are:
Chronic — the symptoms of the disease are weakly expressed, have a permanent character and manifest themselves in the form of aching, dull pain, which increases with physical exertion and after sexual intercourse, menstrual cycle disorders. Periodic exacerbations of the disease are often similar in symptoms to chronic inflammation of the appendages.
Acute — the disease develops in a few days, has pronounced symptoms such as pulsating cramping pain in the lower abdomen, fever, malaise, weakness.
Symptoms of pyosalpinx
The symptoms of pyosalpinx depend on the type of pathogen, the degree of development and the state of the immune system, they have the following manifestations:
acute throbbing pain in the lower abdomen, spreading to the lumbar region and sacrum;
fever, chills, sweating;
nausea, vomiting, headaches, weakness;
tachycardia;
purulent discharge from the vagina;
irregular menstrual cycle;
in the chronic form of pyosalpinx, the pain is constant and increases with the load on the body.
Diagnosis of pyosalpinx
The diagnosis is established based on the data of the medical history, the nature of pain and their localization. If symptoms of pyosalpinx appear, you should immediately consult a doctor. To begin with, a gynecological examination will be performed to determine the size of the uterus and ovaries by palpation. And then a number of instrumental and laboratory studies were assigned. Ultrasound diagnostics will determine the size of the lesion and the exact location. Transvaginal ultrasound will allow us to consider the violation of the echogenicity of the fallopian tube. Signs of inflammation in the body will help to identify a general blood test. In the case of the disease, an increased number of leukocytes and ESR will be detected. Bacteriological seeding of vaginal secretions will determine the type of pathogen. PCR diagnostics will reveal the presence of sexually transmitted infections. In difficult cases, diagnostic laparoscopy is used, which most informatively examines the nature of the disease process and the presence of adhesions in the abdominal cavity. For diagnostic purposes, a vaginal puncture can be performed through the rectum. The resulting pus will indicate the presence of complications and a breakthrough of the contents into the pelvic cavity. This is an indication for surgical intervention.
In case of perforation of the pyosalpinx into the pelvic organs, additional consultations of a urologist and a proctologist, ultrasound of the bladder, cystoscopy, rectoscopy may be required.
Possible complications
Complications of pyosalpinx are conditionally divided into two categories. The first includes disorders that have arisen due to the lack of timely and high-quality treatment: sepsis, peritonitis. Such manifestations can lead to internal organ damage and death. The second category consists of complications that occurred after the treatment of the disease. A typical example is a violation of the patency of the fallopian tubes. Patients who have suffered from such a disease are recommended to be regularly monitored by a gynecologist. According to experts, in the future, complications can lead to ectopic pregnancy and infertility, the spread of inflammatory processes to other organs.
Treatment of pyosalpinx
Treatment of pyosalpinx is carried out in a gynecological hospital. At the early stages of detection of the disease, drug therapy is prescribed, including bed rest, a sparing diet, intravenous antibiotics, taking immunomodulators, vitamin and mineral complexes, anti—inflammatory drugs, detoxification of products produced by the causative agent of the disease.
In the long-term absence of the effect of conservative therapy, as well as in the event of complications, surgical treatment is performed, which includes salpingostomy, laparoscopy and removal of appendages.
Salpingostomy is a puncture of the pyosalpinx followed by the introduction of antiseptics and antibiotics into its cavity. This procedure does not suspend the reproductive function. Punctures are performed every other day. The course includes 3-5 sessions. The duration depends on the stage of neglect of the disease.
Laparoscopy is the removal of the fallopian tube through small incisions in the anterior abdominal wall.
With purulent peritonitis, multiple intra-abdominal abscesses, the possibility of supravaginal amputation of the uterus with unilateral or bilateral removal of appendages is considered.
Tuberculous pyosalpinx requires specific treatment carried out in a tube dispensary.
In the postoperative period, autohemotherapy, electrophoresis, laser therapy, paraffin applications are prescribed to prevent the formation of adhesions and scars. Gynecological acupressure, vibration massage is possible.
When choosing methods of treatment for pyosalpinx, the doctor is guided by the patient’s age and the nature of the course of the disease.
If a patient who has overcome pyosalpinx is planning a pregnancy, then she needs to repeat the course of laparoscopic treatment to restore the lumen of the fallopian tubes.
Prevention of pyosalpinx
In order to avoid the development of pyosalpinx and its possible complications, it is sufficient to carry out timely and high-quality treatment of inflammatory diseases of the genitourinary system, as well as sexually transmitted infections: gonorrhea, ureaplasmosis, gerdenelesis; abandon casual and promiscuous sexual relations, use a condom during sexual contact, observe personal and intimate hygiene, exclude the possibility of hypothermia, regularly visit a gynecologist. Also, prevention includes the refusal of abortions, since most often pyosalpinx is detected after they are performed.
Timely and correct assessment of your condition will avoid active surgical intervention, as well as protect the body from complications leading to infertility. Based on the information provided on the causes of the occurrence and development of pyosalpinx, as well as on the theses related to the prevention of this disease, you can create for yourself a number of patterns, observing which, you can prevent the appearance of the disease or minimize all the risks associated with treatment.
