Salpingo-oophoritis is an inflammatory process with simultaneous involvement of the ovaries and fallopian tubes (appendages of the uterus). In the acute period, it is characterized by pain in the lower abdomen, more intense from the side of inflammation, fever, signs of intoxication. There may be a violation of menstrual function. In the chronic stage, the clinic is less pronounced, periodic relapses of the disease occur. Leads to the formation of adhesions and adhesions in the fallopian tubes, increases the likelihood of salpingo-oophoritis and infertility.
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Salpingo-oophoritis or adnexitis is a one- or two-sided, combined inflammation of the ovaries and fallopian (fallopian) tubes that form the appendages of the uterus. In the structure of inflammatory diseases of the female genital apparatus, inflammation of the appendages (adnexitis) occupies one of the first places. Inflammation of the appendages can be caused by streptococci, enterococci, staphylococci, gonococci, fungi, viruses, Mycobacterium tuberculosis, Escherichia, chlamydia and other microorganisms. Often the cause of salpingo-oophoritis is microbial associations (usually E. coli and Staphylococcus). As a rule, the pathogens of adnexitis are resistant to many antibiotics.
Tuberculosis bacillus, gonococcus usually cause bilateral inflammation of the appendages, streptococcus, staphylococcus and E. coli – unilateral. Hypothermia, STI infection, non-compliance with hygiene standards, stress, promiscuous sexual relations predispose to the development of inflammation of the appendages or its recurrence.
Pathogens of the pathological process in salpingo-oophoritis can enter the fallopian tubes in the following ways:
- hematogenic (with blood flow);
- lymphogenic (with lymph flow);
- descending (from the sigmoid or caecum along the peritoneum);
- ascending (from the vagina into the cervical canal, then into the uterine cavity, fallopian tubes and ovaries).
Hematogenic infection of the appendages occurs in cases of tuberculous lesions of the genitals, lymphogenic and descending – in diseases of the rectum, sigmoid colon and appendix of the cecum. For E. coli, streptococci, staphylococci, ascending anatomical channels of the genital tract serve as entrance gates. Chlamydia and gonococci are able to penetrate undamaged tissues of the genital tract. Often, the infection enters the appendages in several ways at the same time.
The development of the inflammatory process in salpingo-oophoritis begins with the introduction of an infectious agent into the mucous membrane of the fallopian tube with the gradual involvement of the muscular and serous layers. Further, the inflammation spreads to the surrounding tissues: the ovarian epithelium and pelvic peritoneum. Immediately after ovulation, the infection enters the burst follicle or yellow body, developing further in the ovary.
In salpingo-oophoritis, the ovary and the tube are soldered together to form a single inflammatory conglomerate, and then a tubo-ovarian abscess. The outcome of inflammation of the appendages is the development of numerous adhesions that limit the patency of the fallopian tubes. The course of salpingo-oophoritis can be acute, subacute, chronic (without relapses and recurrent).
The grounds for the diagnosis of salpingo-oophoritis are the anamnesis data (introduction of an intrauterine device, abortions, diagnostic curettage, complicated childbirth, factors that led to an exacerbation of inflammation of the appendages, etc.), complaints and the results of objective studies:
- Gynecological examination. With a two-handed gynecological examination, a one- or two-sided painful enlargement of the uterine appendages is determined.
- Microbiological studies. Bacterial culture and examination of urethra, vagina and cervix smears allows to establish a microbial pathogen.
- Ultrasound diagnostics. Ultrasound with salpingo-oophoritis reveals inflammatory formations (hydrosalpinxes, pyosalpinxes) of appendages.
- Laparoscopy. Laparoscopy is used as a diagnostic method for detecting purulent formations and examining the fallopian tubes with simultaneous intracavitary therapeutic procedures for inflammation of the appendages.
- Radiography. In order to determine the patency of the fallopian tubes and the severity of pathological changes in them in chronic salpingo-oophoritis, hysterosalpingography is performed – an X-ray examination of the uterus and appendages with the introduction of a contrast agent.
- Functional tests. In cases of menstrual cycle disorders with inflammation of the appendages, functional tests are carried out to assess the function of the ovaries: measurement of rectal temperature, determination of the pupil symptom, tension of cervical mucus.
Symptoms of acute salpingo-oophoritis
The acute form proceeds with a characteristic clinical picture: intense, sharp pains in the lower abdomen, giving into the anus, sacrum and more pronounced on the side of inflammation, fever, often accompanied by chills, the appearance of unusual mucous or purulent discharge, weakness, bruising, dysuric disorders, bloating. Palpation of the abdomen shows symptoms of muscle protection (irritation of the peritoneum). The blood formula shows leukocytosis with a shift to the left, acceleration of ESR.
Bilateral inflammation of the appendages often develops, combined with inflammation of the uterus. Salpingo-oophoritis can be accompanied by algomenorrhea and menorrhagia. With an increase in inflammatory changes, the formation of a purulent sac–like tumor in the appendage area – a tubovarial abscess. With abscessing, there is a risk of rupture of the fallopian tube and the ingress of purulent contents into the abdominal cavity with the development of pelvioperitonitis. With severe intoxication in the acute phase, changes in the nervous and vascular systems may occur.
Pronounced symptoms with uncomplicated form persist for 7-10 days, then pain gradually weakens, blood and body temperature normalize. The outcome of acute inflammation of the appendages can be a complete clinical recovery (with adequate and timely treatment) or chronization of the process with a long course.
Stages of development
There are four consecutive stages in the development of the acute course of the disease:
- the stage of acute endometritis and salpingitis without symptoms of pelvic peritoneum irritation;
- stage of acute endometritis and salpingitis with symptoms of pelvic peritoneum irritation;
- the stage of acute salpingo-oophoritis, accompanied by the development of inflammatory conglomerate and abscess formation;
- rupture of tubovarial abscess.
During the acute period there are two phases:
- Toxic – with a predominance of aerobic flora and symptoms of intoxication.
- Septic – with the addition of anaerobic flora, the aggravation of symptoms and the development of complications. In the septic phase of the disease, the formation of purulent tuboovarial formation occurs with the threat of perforation.
Treatment of acute salpingo-oophoritis
The acute stage of inflammation of the appendages is subject to inpatient treatment with the creation of conditions for physical and mental rest of the patient, the appointment of an easily digestible diet, an adequate amount of liquid (alkaline drink, juice, tea), observation of excretory function. In acute salpingo-oophoritis, the following is prescribed: antibacterial treatment with broad-spectrum drugs, analgesic, anti-inflammatory, desensitizing treatment.
The main means of therapy are antibiotics, taking into account the sensitivity of the pathogen to the drug. The dose of the antibacterial drug should ensure its maximum concentration in the inflammatory focus. Antibiotics of the following groups are widely used in the treatment of appendage inflammation:
- penicillins (ampicillin, oxacillin);
- tetracyclines (doxacycline and tetracycline);
- fluoroquinolones (ofloxacin, etc.);
- macrolides (azithromycin, erythromycin, roxithromycin);
- aminoglycosides (kanamycin, gentamicin);
- nitroimidazole (metronidazole);
- lincosamides (clindamycin).
In antibacterial therapy, preference is given to antibiotics with a long half—life and excretion (ampicillin — 5 hours, amoxicillin – 8 hours, etc.). In severe clinical course of appendage inflammation, the risk of septic complications, mixed or anaerobic flora, antibiotics in various combinations are prescribed (gentamicin + levomycetin, clindamycin + chloramphenicol, lincomycin + clindamycin, penicillins + aminoglycosides).
The bactericidal effect on the anaerobic flora is provided by metronidazole (administered intravenously or orally). To relieve the symptoms of intoxication, infusion therapy is prescribed: intravenous administration of glucose solutions, dextran, protein preparations, water-salt solutions (total fluid volume up to 2-2.5 liters / day.). With the development of purulent forms of inflammation, surgical treatment is indicated. Today, surgical gynecology widely uses low-traumatic methods of performing operations, including in the treatment of adnexitis.
In acute purulent course of the disease, laparoscopy is performed, during which the pus is removed and irrigation with antiseptics and antibiotics of the inflammatory focus is carried out. Evacuation of the contents of the sac tumor by puncture of the vaginal arches and subsequent local administration of antibiotics is successfully applied. In some cases, with the development of purulent melting of appendages (the increase in renal failure, the threat of opening the abscess, generalization of the septic process), their surgical removal (adnexectomy) is indicated.
After removing the acute symptoms of salpingo-oophoritis, physiotherapy (ultrasound, electrophoresis with magnesium, potassium, zinc on the lower abdomen, vibration massage) and biostimulants are prescribed in the subacute phase. In the absence of timely therapeutic measures, acute salpingo-oophoritis turns into chronic inflammation of the appendages, occurring with periodic exacerbations.
Chronic salpingo-oophoritis is most often the result of an untreated acute process and occurs with relapses resulting from the influence of non-specific factors (stressful situations, hypothermia, fatigue, etc.). Periods of exacerbation of chronic inflammation of the appendages occur with a deterioration in the general well-being of a woman, weakness, the appearance or intensification of pain in the lower abdomen, an increase in body temperature to 37-38 °, the appearance of mucopurulent discharge from the genital tract. After 5-7 days, the symptoms gradually subside, only a moderate aching or dull abdominal pain persists.
50% of patients with chronic salpingo-oophoritis have short-term or persistent menstrual cycle disorders such as menorrhagia, metrorrhagia, algomenorrhea, rarely oligomenorrhea. In 35-40% of women with a chronic course of the disease, there is a disorder of sexual function (soreness during sexual intercourse, a decrease or absence of sexual desire, etc.). With chronic inflammation of the appendages, the function of the digestive organs (colitis, etc.) and urinary excretion (cystitis, bacteriuria, pyelonephritis) is impaired. Frequent relapses lead to the development of neuroses, a decrease in a woman’s ability to work, and the emergence of conflict situations in the family.
Exacerbation of chronic salpingo-oophoritis can occur in two variants:
- infectious-toxic – with an increase in pathological secretion, exudative processes in the appendages of the uterus, an increase in their soreness, changes in the blood formula;
- neuro-vegetative – with deterioration of well-being, decreased ability to work, mood instability, vascular and endocrine disorders.
Chronic recurrent inflammation of the appendages often leads to the development of pathological pregnancy outcomes (ectopic pregnancy, spontaneous miscarriage), secondary infertility. Infertility can be not only a consequence of anatomical and functional changes in the fallopian tubes, but also disorders of ovarian function (menstrual cycle disorder, anovulation, etc.). Such mixed forms of infertility resulting from inflammation of the appendages are extremely difficult to treat.
The formation of infiltrates, the development of sclerotic processes in the fallopian tubes and their obstruction, the formation of adhesive processes around the ovaries are noted. From a chronic focus, the infection can spread to other organs and cause chronic colitis, cholecystitis, pyelonephritis.
Treatment of chronic salpingo-oophoritis
In the acute stage, therapeutic measures are carried out that correspond to the acute process (hospitalization, antibacterial, infusion, desensitizing therapy, vitamins). After the aggravation of inflammation of the appendages subsides, autohemotherapy, aloe injections, physiotherapy (UV irradiation, electrophoresis with drugs (lidase, potassium, iodine, magnesium, zinc), UHF therapy, ultrasound, vibration massage) are recommended under the control of laboratory and clinical parameters.
Physiotherapy procedures have a resorbing and analgesic effect, help to reduce the formation of adhesions. Therapeutic mud (ozokerite), paraffin treatment, therapeutic baths and vaginal irrigation with sodium chloride, sulfide mineral waters are effective. In the stage of persistent remission, spa treatment is indicated.
Following a diet strengthens the body’s resistance to infectious agents, improves metabolic processes in the focus of inflammation. During the acute and subacute stages, a hypoallergenic diet is prescribed, excluding egg whites, mushrooms, chocolate, sweets, etc. and limiting the amount of table salt and carbohydrates. The total caloric content of the daily diet includes 100 g of protein, 70 g of fat, 270-300 g of carbohydrates (2300 kcal per day). The recommended heat treatment of food is cooking or stewing.
Outside of exacerbation, strict adherence to a diet is not necessary, but the diet should be balanced and rational with sufficient intake of protein and vitamins.
The risk group includes women suffering from sexual infections, using intrauterine contraceptives, who have undergone operations on reproductive organs, as well as after pregnancies that ended with artificial or spontaneous abortions. The threat of the development of the consequences of the disease indicates the need to take care of your health and take timely preventive measures:
- exclusion of factors provoking the development of acute adnexitis and relapses of chronic inflammation of the appendages (hypothermia, stress, sexual infections, alcohol abuse, spicy food, etc.);
- the use of rational contraception, prevention of abortions;
- if necessary – medical termination of pregnancy or mini-abortions;
- conducting timely, rational and complete complex therapy of inflammatory diseases of the pelvic organs, including inflammation of the appendages, taking into account the pathogen;
- systematic consultations with a gynecologist every 6-12 months.