Hydrosalpinx
The content of the article:
- Causes and risk factors
- Forms
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Hydrosalpinx (from ancient Greek ǔδωρ - "water" and σάλπιγξ - "pipe") is a one- or two-sided saccular enlargement of the fallopian tube, filled with a transparent serous uninfected fluid (transudate), which forms against a background of inflammation due to soldering of the ampulla of the fallopian tube.
Approximately one third of patients with confirmed tubal infertility are diagnosed with this pathological condition. In addition to reducing the likelihood of a natural pregnancy (by approximately 50%), with hydrosalpinx, the prognosis for implantation of a fertilized egg during in vitro fertilization (IVF) worsens, the frequency of ectopic pregnancies and miscarriages increases (on average, 2 times).
Hydrosalpinx is a pathology in which there is a violation of the patency of the fallopian tubes
Causes and risk factors
The cause of the accumulation of serous fluid in the lumen of the fallopian tube is its inflammation, which develops as a result of the following diseases and conditions:
- inflammatory process in the fallopian tubes, ovaries (salpingitis, salpingo-oophoritis);
- endometritis, endometriosis;
- sexually transmitted infections;
- prolonged wearing of an intrauterine device;
- therapeutic and diagnostic manipulations on the fallopian tubes and uterus;
- acute or chronic inflammatory diseases of the vagina, cervix;
- the presence of masses in the uterine cavity;
- congenital malformations of the fallopian tubes;
- genital tuberculosis.
Normally, the fallopian tubes are hollow muscular tubular organs ranging in length from 7 to 12 cm, extending in both directions from the uterus towards the ovaries. One end of the fallopian tube is connected to the uterine cavity by the uterine opening, the other, expanding in a funnel-shaped manner, opens in the abdominal cavity in the immediate vicinity of the ovary. The funnel of the fallopian tube is bordered by fringes (fimbriae), which, making sweeping movements, move the fertilized egg into the lumen of the tube in order to transport it to the uterine cavity.
The structure of the female genital organs
The mucous membrane lining the lumen of the tubes from the inside has a longitudinal folding, contains cells that produce a special secret, and microscopic mobile cilia; the pipes themselves perform peristaltic movements (contractions). These adaptive mechanisms facilitate the progression of the egg to the implantation site.
In inflammatory processes, adhesions form in the fallopian tubes, impairing their peristaltic activity and disrupting the drainage of secretions inside the oviducts. The fimbriae of the funnel are glued together and with the surrounding tissues, blindly closing the lumen of the tube (the initial part of the organ in contact with the uterine cavity can also undergo similar changes). As a result, the fallopian tube from the organ that is the conductor of the egg from the ovary to the uterus turns into a closed formation, where mucus accumulates and secondary inflammatory changes develop. The fallopian tubes in this case are functionally inconsistent.
Forms
Depending on the morphological manifestations of hydrosalpinx it happens:
- single-chamber (this is a fusiform, oval or S-shaped formation, the longitudinal size of which is 2-3 times larger than the transverse one);
- multi-chamber (there are from 2 to 8 closed cavities located one after another in the form of a chain).
If the adhesive process is not active enough and the bonding of the fringes of the funnel of the pipe or its initial section is loose, a breakthrough of the hydrosalpinx into the pelvic cavity or into the uterine cavity is possible during straining, intense physical exertion. In such a situation, one speaks of a valve (drained) hydrosalpinx.
According to the involvement of the fallopian tubes:
- one-sided hydrosalpinx;
- bilateral hydrosalpinx.
With the flow:
- acute;
- chronic.
Symptoms
The symptoms of chronic hydrosalpinx are usually nonspecific:
- pulling, bursting, non-intense pain in the iliac region;
- intermittent watery discharge (with a breakthrough of the drained hydrosalpinx into the uterine cavity);
- subfebrile body temperature;
- soreness or discomfort during intercourse;
- pulling pains in the lower abdomen with the spread of the adhesive process into the pelvic cavity (periodically erupting valve hydrosalpinx);
- menstrual irregularities;
- inability to get pregnant.
Often, hydrosalpinx is asymptomatic for a long time and is diagnosed during examination for infertility or with the development of acute complications.
With chronic hydrosalpinx, non-intense pain occurs in the iliac region, with acute - pronounced and pulsating
In an acute, intensively growing process, the pain acquires a pronounced pulsating character, a significant rise in body temperature is possible, symptoms of intoxication (headache, loss of appetite, drowsiness, deterioration in general well-being) join.
Diagnostics
The basis for the diagnosis of hydrosalpinx is the results of a gynecological examination and data from instrumental research methods:
- bimanual vaginal examination;
- Ultrasound examination with a transvaginal sensor;
- X-ray examination (hysterosalpingography);
- laparoscopy;
- magnetic resonance imaging or computed tomography (in case of difficulty in making a diagnosis).
To diagnose hydrosalpinx, transvaginal ultrasound is performed
Laboratory research methods (general and biochemical blood tests, general urinalysis) are not indicative, since there are no laboratory criteria for the disease.
Treatment
Hydrosalpinx treatment begins with conservative methods:
- etiotropic therapy (antibacterial, antimicrobial drugs);
- strengthening the immune system (immunostimulants);
- vitamin therapy;
- physiotherapeutic procedures (magneto- and electrophoresis, ultraviolet radiation, electrical stimulation, etc.).
If conservative measures are ineffective, surgical treatment is indicated (in the overwhelming majority of cases, endoscopic):
- salpingoovariolysis (dissection of adhesions in the small pelvis, restoration of patency of the fallopian tubes);
- fimbriolysis and fimbrioplasty (elimination of the adhesions in the area of the fimbria of the fallopian tubes);
- salpingostomy and salpingoneostomy (formation of a new opening for the exit of the fallopian tube);
- tubectomy (removal of a tube or tubes, is carried out if it is impossible to restore patency if other therapeutic measures are ineffective).
If conservative therapy is ineffective, hydrosalpinx is surgically treated
Possible complications and consequences
Complications of hydrosalpinx can be:
- suppuration of hydrosalpinx (pyosalpinx);
- adhesion in the pelvic cavity;
- ectopic (tubal pregnancy);
- miscarriage;
- infertility;
- in the case of IVF - ineffectiveness of the procedure, spontaneous termination of the pregnancy that has arisen;
- rupture of the fallopian tube.
Forecast
Even with successful restoration of patency and elimination of the adhesive process in the case of prolonged sluggish inflammation, the full functional capacity of the tubes is significantly reduced, since the microvilli of the mucous membrane lose their proper mobility and peristalsis slows down. Patients who have undergone salpingo-ovarian or fimbriolysis in this situation are at risk of tubal (ectopic) pregnancy.
With the restored patency of the tube and removal of the acute hydrosalpinx, conception naturally and bearing of the fetus occur in about 75% of cases, and the probability of an ectopic pregnancy does not exceed 5%.
Prevention
The following measures must be observed:
- Timely treatment of inflammatory diseases of the pelvic organs.
- Prevention of sexually transmitted infections.
- Comprehensive examination in case of infertility or recurrent miscarriage.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
