Hematosalpinx is a pathological condition in which blood accumulates in the lumen of the fallopian tube. The main manifestation of the disease is pulling pains in the lower abdomen and lumbar region. Pain sensations have different intensity, are most present on the side of the lesion, may periodically subside and reappear. Laboratory tests, clinical examination, abdominal and transvaginal ultrasound are used for diagnosis. The most informative method of research is diagnostic laparoscopy. Hematosalpinx is treated surgically with the subsequent use of drug and physiotherapy.
Hematosalpinx is considered as a complication of the underlying disease. Most often it is acquired (with ectopic pregnancy), but there are also congenital forms associated with malformations of the reproductive system (4-7%). In the latter case, pathology is diagnosed in adolescent girls with the onset of menstruation (at 11-13 years). In practical gynecology, much attention is paid to the diagnosis, treatment and prevention of the development of hematosalpinx, since the reproductive function of a woman directly depends on it.
When the contents accumulate in the fallopian tube, its abdominal end sticks together, and the blood begins to stretch the tube walls. Gradually, a tumor forms: first elastic and mobile (fluid), then bumpy and tortuous due to the organization of blood clots and clots. The following causes of hematosalpinx are distinguished:
- Aborted tubal pregnancy. In spontaneous abortion, the tubar lumen is closed by blood clots that form hematosalpinx. Usually the bleeding does not stop or stops for a while. Therefore, the muscle walls gradually stretch, which can lead to a rupture of the pipe.
- Congenital malformations. This is the absence of natural channels (atresia) of the uterine end of the tube, vagina or hymen. With the onset of menstruation, blood gradually accumulates in the internal genitals and overflows the vagina, uterus, and then begins to fill and stretch the fallopian tubes.
- Twisting of appendages. It occurs more often with inflammatory pathology of the tubes, but it can also happen in a healthy state. Basically, the twisting of the appendages occurs in young women during sudden body movements, performing exercises that cause an increase in intra-abdominal pressure. The tubes are squeezed, the vessels of the shells are injured, the cavity begins to fill with blood.
- Endometriosis. Tube damage in endometriosis occurs in less than 10% of cases and is usually combined with endometriosis of the uterine body. Foci of endometrioid tissue attach and grow in the tube wall, producing hemorrhagic contents and forming hematosalpinx.
The hematosalpinx is based on the accumulation of hemorrhagic contents (blood) in the fallopian tube. The process can be one- or two-way. Blood comes from the uterus or from pathologically altered vessels of the mucosa. The villi located at the abdominal end of the tube are soaked with blood, then glued together with fibrin threads. A sealed pipe is a closed cavity in which blood accumulates. Gradually, the fluid is organized into clots, and then into a lumpy blood tumor.
The clinical picture consists of the symptoms of bleeding and the clinic of “acute abdomen”. When chorionic villi grow into the wall during tubal pregnancy, it ruptures, and signs of acute surgical pathology come to the fore: sharp pain in the lower abdomen (acute or paroxysmal), reflex vomiting, impaired bowel and bladder function. The patients assume a forced sitting position, the facial expression is pained, with pointed features. The same clinic is typical for the twisting of appendages.
In the future, symptoms of increasing intra-abdominal bleeding are added: pallor of the skin, tachycardia, cold sweat. The patient’s pupils are dilated from fright, breathing is shallow and intermittent. There is pain in the shoulder and shoulder blade from the side of the lesion, due to blood irritation of the thoracic nerve.
The body temperature remains normal or even lowered. After a few hours, a fever may appear due to the absorption of products of destruction of red blood cells in the abdominal cavity. Scanty dark or chocolate spotting is observed from the genital tract.
The hematosalpinx clinic is different due to malformations. Manifestations increase gradually, the process drags on for years. Complaints first arise with the onset of menstruation, when blood, having no outlet outside, begins to accumulate inside the genital tract.
The lower the level of atresia, the longer the accumulation of blood. As a result, a huge blood tumor can form. The intensity of pain increases with each subsequent monthly, is not stopped by painkillers. In the future, the pain persists in the intermenstrual period.
Hematosalpinx due to interrupted tubal pregnancy usually develops at 4-6 weeks of gestation. Due to the overgrowth of the walls with blood and the germination of chorionic villi, hematosalpinx is complicated by a tubal rupture and massive intra-abdominal bleeding.
In the presence of inflammatory changes in the tubar wall, hematosalpinx can become infected and fester, with rupture in this case, purulent peritonitis develops. With malformations, blood accumulates gradually, the ovary and the tube are soldered into an inseparable tumor conglomerate — a tuboovarian tumor — with a complete loss of their functions.
If hematosalpinx is suspected, the patient is examined by an obstetrician-gynecologist, surgeon. Laboratory, physical and instrumental examination is carried out in a hospital:
- Laboratory tests. In blood tests (general analysis, biochemistry, coagulogram), attention is paid to signs of blood loss and clotting indicators. In the case of a suspected pregnancy, an analysis for beta-hCG is given.
- Gynecological examination. The examination on the chair should be carried out very carefully so as not to cause a rupture of the overgrown fallopian tube. During a two-handed examination, a lumpy, painful formation is palpated, the ovary is not separately determined. With atresia of the hymen or the lower third of the vagina, cyanosis of the mucous membranes, protrusion of the hymen from the genital slit is visually determined, and with rectal examination – a stretched vagina of a tight elastic consistency.
- Combined ultrasound of the uterus and appendages. Sonography visualizes dilated fallopian tubes filled with heterogeneous contents (blood, pus), multiple adhesions and septa, a sludge phenomenon may occur – sensor—displaced conglomerates consisting of shaped elements. Fluid is often detected in the rectal-uterine recess.
- Diagnostic laparoscopy. Laparoscopy is the “gold standard” for the diagnosis of hematosalpinx. In the presence of symptoms of an acute abdomen, an accurate differential diagnosis can be carried out only during surgery.
Hematosalpinx most often manifests itself as an urgent surgical condition, therefore, treatment begins with the removal of the affected fallopian tube (salpingectomy) or tubovarial formation if it is impossible to isolate the ovary, sanitation of the abdominal cavity when the formation ruptures. Laparoscopic access is preferred.
Tubal puncture with removal of the contents is not recommended. Firstly, a blood tumor does not always consist of liquid contents. Secondly, the tubar walls thin out, atrophy, and a rupture may occur during the evacuation of blood. In case of atresia of the lower parts of the genital tract, after removal of the tube, careful aspiration of the contents from the vagina is performed, followed by recanalization.
In the postoperative period, anti-inflammatory (NSAIDs, dexamethasone) and enzyme resorption (hyaluronidase) therapy is prescribed. Physiotherapy methods are effective:
- electrotherapy with constant and pulsed currents — has an analgesic effect, stimulates blood circulation;
- ultrasound therapy — activates the work of the ovaries, has a resorbing effect;
- applications of ozokerite and paraffin — accelerate regenerative processes;
- mud treatment — stimulates metabolism, increases local immunity.
Prognosis and prevention
With timely surgical treatment, the prognosis for life is favorable. Salpingectomy increases the effectiveness of assisted reproductive technologies, which contributes to the onset of the desired pregnancy.
To prevent the development of hematosalpinx, it is necessary to carefully treat inflammatory diseases of the pelvic organs; observe personal and intimate hygiene; regularly undergo preventive examinations. No later than 3 years old, the girl should be examined by a pediatric gynecologist for examination for malformations.