Gynecology

Acute salpingitis and oophoritis

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Included:

  • abscess:
    • uterine tube
    • ovary
    • tubo-ovarian
  • piosalpinx
  • salpingo-oophoritis
  • tubo-ovarian inflammatory disease

If necessary to identify the infectious agent, an additional code is used (B95-B98).

In Russia International Classification of Diseases 10th revision (ICD-10) adopted as a single regulatory document to account for the incidence, causes of public calls to medical institutions of all departments, causes of death.

ICD-10 introduced into the practice of health care throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia dated May 27, 1997. №170

The release of a new revision (ICD-11) is planned by WHO in 2022.

ICD-10 classes

In Russia International Classification of Diseases 10th revision (ICD-10) adopted as a single regulatory document to account for the incidence, causes of public calls to medical institutions of all departments, causes of death.

ICD-10 introduced into the practice of health care throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia dated May 27, 1997. №170

The release of a new revision (ICD-11) is planned by WHO in 2017 2018

Definition and General Information [edit]

Salpingo-oophoritis (adnexitis) is an infectious-inflammatory process of non-specific or specific etiology in the fallopian tubes and ovaries. This is the most common inflammatory disease of the pelvic organs (PID).

Oophoritis is almost always combined with salpingitis.

• Acute non-specific (or specific) salpingo-oophoritis.

• Exacerbation of chronic nonspecific salpingoophoritis.

• Chronic nonspecific salpingo-oophoritis.

Etiology and pathogenesis [edit]

Nonspecific (non-gonorrhea) salpingoophoritis is caused by pathogenic and opportunistic pathogens. Often see a mixed infection.

At first, all signs of inflammation appear on the mucous membrane of the fallopian tubes (endosalpinx): hyperemia, microcirculation disorders, exudation, edema, cellular infiltration. Then the inflammation spreads to the muscular layer of the fallopian tube. The tube thickens and lengthens, its palpation becomes painful. Microorganisms along with the contents of the tube enter the abdominal cavity, affecting the serous cover of the tube and the surrounding peritoneum. Occurs perisalpingitis and pelvioperitonit. After ovulation, the pathogens infect the granulosa of the follicle and the inflammatory process in the ovary develops (oophoritis). When suppuration occurs tubo-ovarian formation. The adhesive process in the ampullary region and the mouth of the fallopian tube develops very rapidly due to thickening of the fimbriae and exudation. Exudate accumulates in the pipe with the formation of hydrosalpinx. Adhesions in the pelvis arise due to the "gluing" of inflammatory-modified fallopian tubes with the peritoneum of the abdominal space, loops of the intestine, and the vermiform process (secondary appendicitis is often developed).

Clinical manifestations [edit]

The first symptom of acute salpingoophoritis is severe pain in the lower abdomen, accompanied by an increase in body temperature of up to 38 ° C (sometimes with chills). Dysuria, bloating and dyspepsia are also possible. The condition of the patient is usually moderate, worried about weakness, headache, loss of appetite.

With adequate treatment, acute inflammation ends with recovery. Sometimes the disease becomes a subacute or chronic process with frequent exacerbations. During an exacerbation, the body temperature is low-grade or normal, disturbed by dull, aching pain in the lower abdomen and in the lower back. Often complaints of dyspareunia and infertility.

Salpingitis and oophoritis: Diagnosis [edit]

In the history pay attention to complicated labor, abortion, intrauterine invasive manipulation, curettage, GHA (hysterosalpingography), hysteroscopy, use of the IUD (intrauterine contraception), casual sex, etc.

In acute inflammation, bimanual examination is always painful (especially in the area of ​​the appendages), as the pelvic peritoneum is involved (sometimes symptoms of peritoneal irritation are determined), the appendages are not clearly defined, the tissue in the projection of the appendages is swollen, pasty consistency. In the study with the help of mirrors, inflammatory endocervicitis and serous-pussy discharge from the external pharynx are often found. In the chronic process, the appendages are also painful, but to a lesser extent, hardening and fibrosis of the fallopian tubes with the formation of adhesions limits their mobility, and movements beyond the cervix are painful.

Bacterioscopic and bacteriological studies of the discharge from the cervical canal, vagina and urethra are performed to detect pathogens and determine their sensitivity to antibiotics.

In blood tests, nonspecific changes: in the acute process - leukocytosis, leukocyte shift to the left, increased ESR, dysproteinemia with prevalence of globulin fractions, increased C-reactive protein, in a chronic process - only an increase in ESR.

There are no clear ultrasound signs of salpingoophoritis. Sometimes it is possible to visualize thickened fallopian tubes, suggest adhesions in the pelvis. When pelvioperitonite detect a small amount of fluid behind the uterus. Tumor-like tubo-ovarian formations can also be visualized. Sometimes CT or MRI is used, especially in differential diagnosis with ovarian tumors.

Acute salpingitis and oophoritis: Treatment [edit]

In the chronic process or in the rehabilitation period after an acute process, physiotherapeutic methods are used: ultra-high-frequency therapy (UHF-therapy), magnetic therapy, electrophoresis with zinc, magnesium, hyaluronidase, etc., diadynamic currents, sanatorium-resort therapy (radon baths and irrigation, thalassotherapy) .

Antibacterial treatment is usually prescribed empirically, taking into account the most likely pathogens. The schemes of the first choice include a combination of 3rd generation cephalosporins (cefotaxime, ceftriaxone) with metronidazole, inhibitor-protected aminopenicillins (amoxicillin + clavulanic acid, etc.).

Alternative schemes: linkosamides in combination with aminoglycosides of the 2-3rd generation, fluoroquinolones (ciprofloxacin, ofloxacin) with metronidazole, carbapenems. Given the high risk of chlamydial infection, doxycycline or macrolides are prescribed.

Antibacterial treatment of acute salpingoophoritis, as a rule, begins with the intravenous administration of drugs with the subsequent transition to their ingestion. Treatment of milder forms of the disease is carried out on an outpatient basis. In this case, prescribed drugs for oral administration with high bioavailability. Antibacterial treatment combined with detoxification infusion therapy: injected with saline solutions, 5% glucose solution, reopolyglukine, hemodez, mafusol, vitamins, protein drugs, etc.

According to the indications prescribed analgesics, NSAIDs topically (candles), cold on the stomach.

According to indications use diagnostic laparoscopy. In acute inflammatory processes, an antibiotic solution is sometimes injected into the abdominal cavity (ampicillin 1 g per 20 ml of saline). Further, surgical treatment is used in the absence of the effect of conservative medical therapy and the formation of purulent tubo-ovarian formations.

Other [edit]

Pyo-inflammatory tubo-ovarian formations

Definition and General Information

Acute suppurative salpingitis - inflammation of the fallopian tube with its suppuration.

Purulent tubo-ovarian abscess - purulent fusion of the fallopian tube and ovary with the formation of a single cavity, surrounded by a pyogenic capsule.

4-5% of women are diagnosed with purulent inflammatory diseases of the fallopian tubes and ovaries.

Polybacterial etiology, in the pathogenesis of the ascending infection predominates from the lower part of the genital tract. The spread of microorganisms also occurs from extragenital foci, including from the intestine. Micro- and macrodamages during invasive interventions - the entrance gate of the infection. At the same time, anaerobes play a significant role, as they penetrate from the neighboring “ecological niches” - the skin, the mucous membranes of the vagina and the cervical canal, the large intestine, the external genital organs. Inflammatory diseases of the uterus often precede endometritis, then ascending the process captures the isthmic and ampullar sections of the fallopian tube, turning into purulent salpingitis. The germinal epithelium in the ovaries is a fairly powerful barrier to infection, so the ovaries are mainly affected by cystic formations. That is why the purulent process in the ovaries is observed more often simultaneously with pyosalpinx in the form of an inflammatory tubo-ovarian formation (adnextum). With perforation of a purulent formation (or without it), pelvic abscesses or gynecological peritonitis may develop. Purulent tubo-ovarian abscesses may also be formed due to exacerbation of chronic salpingo-oophoritis.

It depends on the form of suppurative inflammatory disease: complicated and uncomplicated. Uncomplicated form includes acute purulent salpingitis, complicated forms include all confined inflammatory tumors of the appendages (purulent tubo-ovarian formations).

The purulent salpingitis and the purulent tubo-ovarian formations in the acute stage of inflammation proceed with a similar clinical picture and resemble the course of a specific process with suppuration (gonorrhea). Purulent salpingitis begins acutely with an increase in body temperature, tachycardia, acute local pain in the left or right hypogastric region, radiating to the lower back, rectum and thigh on the affected side. The common nature of pain (throughout the abdomen) is observed with pelvioperitonitis, which requires a differential diagnosis with surgical diseases of the abdominal cavity. A persistent symptom of purulent salpingitis is abnormal purulent discharge from the vagina, cervical canal and urethra (urethritis and cervical cystitis), which are accompanied by dysuric disorders and dyspareunia. Symptoms of irritable bowel may occur in the form of frequent and loose stools. As a result of intoxication, emotional-neurotic disorders with symptoms of agitation or depression and emotional lability are observed.

When vaginal examination of the appendages often can not be palpated due to sharp pain. Typical soreness when moving behind the cervix and palpation of the posterior and lateral vaginal arches.

Laboratory data: moderate leukocytosis, leukocyte shift to the left and an increase in ESR. The decisive role in the favorable outcome is played by the early diagnosis of the disease at the stage of purulent salpingitis and adequate treatment.

Differential diagnostics with acute surgical diseases of the abdominal organs (acute appendicitis, cholecystitis, intestinal obstruction, surgical peritonitis, oncological process) are carried out.

Conservative treatment is limited in cases where it is difficult to distinguish an acute inflammatory process without suppuration from purulent. In the absence of the effect of conservative treatment resort to surgical intervention.

Conservative treatment in the development of suppurative processes leads to relapses, exacerbates metabolic disorders and leads to severe renal dysfunction, increases the risk of impending surgery. If the diagnosis of a purulent process is established, complex treatment is indicated, which includes preoperative medical preparation, timely surgical treatment aimed at removing the focus of destruction, intensive multi-component treatment in the postoperative period, early hospital and post-hospital rehabilitation.

Before and after the operation, antibiotics, antiprotozoal, antimycotic drugs, uroseptics, infusion therapy for the purpose of detoxification, correction of volemic and metabolic disorders, antihistamines are used. After surgery, in addition, prescribe drugs that normalize the motility of the gastrointestinal tract, enzymes, apply hyperbaric oxygenation, hemosorption or plasmapheresis, epidural blockade. Hepatotropic drugs, immunostimulating treatment (ultraviolet irradiation, laser irradiation of blood, immunocorrectors), anti-anemic and restorative treatment, parenteral nutrition, etc. are also used (by indications).

Palliative surgery (puncture of an abscess or colpotomy) is possible only with the threat of perforation of an abscess into the abdominal cavity (to prevent the development of peritonitis), with the formation of fistulas or with extremely severe intoxication. In the presence of sacculated purulent tubo-ovarian formation, the choice of surgical intervention method, the access, the volume of the operation, the time it is carried out in each particular case are determined individually.

Laparoscopic approach is most often used in the surgical treatment of purulent salpingitis and some complications of the purulent process (pyosalpinx, pyovar, purulent tubo-ovarian formation) with disease prevalence of more than 2-3 weeks. Laparoscopy is always used in unclear cases and in the difficulties of differential diagnosis (acute appendicitis, acute salpingo-oophoritis, etc.), especially in young women.

Laparotomic access is used in the surgical treatment of encysing purulent tubo-ovarian formations and their complications (secondary appendicitis, rectitis, sigmoiditis, omentitis, peritonitis). The success of the operation, atraumatic, the possibility of radical removal of purulent-necrotic tissues with a sparing volume of the operation depend on the choice of anesthesia and the skill of the surgeon.

Favorable for life (lethal outcomes are extremely rare), and to preserve reproductive function, it is limited, since it is often necessary to remove the fallopian tubes and ovaries, and often the scar-adhesive process develops in the pelvis.

Adnexitis - a gynecological disease in women

Gynecological disease Adnexitis is an inflammation of the uterus, caused by various infections, as shown in the photo.

Often the etiology of the disease is the effect of streptococci, staphylococci or Escherichia coli on the female genitals.

More inflammation of the appendages may appear in case of contact with infectious agents. This type of infection is sexually transmitted by species such as gonococci, which causes gonorrheal adnexitis. A rare cause of inflammation can be the tuberculosis process, which spreads through the vessels of a woman’s body.

Most often occurs in women aged 20-45 years. Women's disease Adnexitis is considered dangerous, since with no treatment on time, it leads to more serious health consequences and eventually provoke infertility or ectopic pregnancy. But even when pregnancy begins, newborns in the first half of the year often suffer from thrush or candidiasis.

What is salpingoophoritis

Inflammation of the appendages is a general term and therefore often in medicine it is referred to as salpingo-oophoritis. The development of the disease is due to the destruction of the epithelium of the fallopian tubes, as a result of which their walls are impregnated with the products of vital activity of microorganisms, and thereby causing an inflammatory process. What is salpingo-oophoritis in women and what the name of the disease is derived from.

By uterine appendages are meant fallopian tubes, ovaries and ligaments. Diseases such as Salpingitis and Oophoritis develop. First of all, the pathology covers mucous tubes and walls, as a result of which a characteristic fluid and even pus is formed in them. At this stage of development is called Salpingitis. When inflammation occurs in the ovaries, the disease is called Oophoritis. Then, when both organs are affected, they have the common name Salpingo-oophoritis.

Therefore, when signs of inflammation of the appendages appear in a woman, female diseases Adnexitis, Salpingitis, Oophoritis, which have a common pathogenesis and are, in fact, varieties of one disease, are diagnosed

Depending on the path of infection in the woman's body, there are:

  1. the ascending pathway, when the pathogen of pathology penetrates the vagina and cervix,
  2. the descending path, that is, the infection penetrates through other affected organs,
  3. lymphogenous way in which the lesion occurs through the lymph nodes,
  4. hematogenous route when the infection spreads through the blood vessels.

Forms: subacute, acute, chronic

Depending on the clinical course, they are divided into acute, subacute and chronic salpingo-oophoritis, we will understand what this means and what is the difference between them.

  1. The acute form is expressed in a stormy and painful course with pronounced symptoms with a sharp rise in temperature.
  2. Subacute Salpingo-oophoritis is accompanied by an erased clinical course without obvious symptoms with a low temperature, characterized by a small amount of vaginal discharge.
  3. Сальпингоофорит хронический характеризуется вялотекущим процессом с четкими периодами ремиссии и обострения в течение долгого периода времени. При этом женщину постоянно беспокоит ноющая боль в области малого таза.

Код по мкб 10

Especially for the systematization and analysis of data on all existing diseases, a special guidebook ICD 10 (International Classification of Diseases 10-Revision) was created, which is a tool for doctors.

It contains information on any pathology and each of them has its own specific code. Inflammation of the appendages is divided into several varieties and, according to the reference book, is included in the category “Inflammatory diseases of the female pelvic organs” with the numbering of codes N70-N77.

The salpingoophoritis code for ICD 10 corresponds to N70, and the category is called “Salpingitis and oophoritis” and includes the following subcategories:

  • Acute adnexitis code in microcircuit 10 - N70.0,
  • chronic adnexitis code according to MKB 10 - N70.1,
  • unspecified adnexitis code according to MKB 10 - N70.9.

Under the code IC70 10, all varieties of the chronic form of both 2-sided and one-sided salpingo-oophoritis are included. Adnexitis can lead to such a disease as acute cystitis code according to ICD 10 under No. 30.0

Types: left-sided, right-sided, double-sided

Depending on the area of ​​damage, adnexitis can be of several types, and left-sided inflammation is more often diagnosed than right-sided.

The infectious agent enters the right fallopian tube and thereby causes inflammation not only in it, but also in the right ovary, and the disease is diagnosed as right-sided salpingo-oophoritis. It is divided into acute form or running chronic.

If organs on the left side are affected, left-sided adnexitis is distinguished, which, in turn, is divided into categories according to the form of flow:

  1. chronic left-sided salpingo-oophoritis,
  2. acute left-sided salpingo-oophoritis.

With the development of pathology from two sides at the same time, the disease is classified as bilateral inflammation of the appendages with subcategories:

  • acute bilateral salpingo-oophoritis,
  • chronic bilateral salpingo-oophoritis.

Causes

Symptoms and causes of Adnexitis in women can be different depending on the infection causing the inflammatory process, as well as the conditions for the development of pathogenic microflora. In medicine, there are several risk factors that can contribute to the development of pathology:

  1. frequent changes of sexual partner or non-use of contraceptives during sex,
  2. hypothermia of the body. Often develops after swimming in the sea or visiting the pool, regardless of the time of year. Hypothermia can be caused by wearing light clothing during cold weather,
  3. weakened immunity against the background of regular nervous stress,
  4. hormonal failure and menstrual disorders,
  5. chronic cystitis,
  6. neglect of personal hygiene,
  7. use of intrauterine device for a long time,
  8. in various medical procedures (childbirth, cleaning after a miscarriage or abortion, examination by a doctor),
  9. sexual contact during menstruation.

All these factors contribute to another frequently occurring disease in women: thrush, which can occur on the background of Adnexitis. Treatment of thrush is outpatient, you can choose effective pills from thrush for women, who even in 1 day will be able to cope with the disease.

Often the development of salpingoophoritis is associated with related problems, such as acute respiratory viral infections, herpes, influenza, or appears due to the inordinate use of hormonal drugs.

Not the last role played by psychosomatics, that is, the cause of the development of the disease, experts believe internal psychological factors. A woman to some extent feels defective or cannot understand how to behave with a man and thereby realize her feminine qualities. As a result, she herself comes up with a disease on a psychological level. Then chronic adnexitis is treated not only with medication, but also prescribed regular visits to the psychologist.

Symptoms in women

Symptoms and treatment of adnexitis in women may vary depending on the form and type of infection. Signs of inflammation can be felt either on the one hand with left-side or right-sided disease, or on both sides at the same time if chronic bilateral adnexitis develops.

In the acute form of salpingoophoritis, the following symptoms appear:

  1. bloating
  2. nausea,
  3. vomiting
  4. the lower abdomen hurts badly, which can give to the lower back,
  5. frequent urination with burning sensation when emptying the bladder,
  6. increased body temperature causing chills,
  7. dizziness,
  8. complaints about the deterioration of the general condition of the body,
  9. bleeding between menstrual cycles
  10. purulent or mucous discharge of brown color, in rare cases bloody.

In the absence of timely and topical treatment, the acute form becomes chronic, but there are already some other symptoms. At the same time, salpingo-oophoritis bilateral chronic is expressed in the same symptoms as the right-sided or left-sided:

  • constant dull pain in the lower abdomen, which gives to the leg or thigh,
  • thrush,
  • monthly delay or cycle failure
  • reduced sexual desire
  • frequent manifestations of cystitis
  • body temperature fluctuates between 37 and 37.5.

In order to find out which antibiotics to drink for chronic adnexitis, it is necessary to go to a doctor's appointment at the first signs of exacerbation.

Diagnosis and diagnosis

Establishing the diagnosis of Salpingo-oophoritis in some cases can be a very difficult task, since at an early stage of development, the symptoms are the same as for vaginitis, endometriosis, hydrosalpinx or metroendometritis. Therefore, differential diagnosis is used to help recognize or eliminate the fear. A complete blood and urine test is performed, and an ultrasound scan is assigned, mr.

A smear of more than 100 leukocytes indicates that the woman has an inflammatory process in the body. To confirm, the doctor with the help of an ultrasound scanner can check for the identification of echo signs of pathology.
Based on the protocol of the examinations, the doctor makes a conclusion and makes a diagnosis.

Treatment (with antibiotics and suppositories)

With the diagnosis of adnexitis, treatment with antibiotics and suppositories takes place in a hospital with bed rest. First of all, treatment is directed to reducing the pain in a woman, and further therapy is carried out to eliminate the cause of the disease.

The scheme and tactics of treatment consists of several stages, which is carried out in accordance with all the recommendations of the doctor. How to treat adnexitis, and which of the drugs are better for stabbing, and which pills can be administered only by a qualified specialist.

The list of drugs used in the treatment of:

Acute

Depending on the form of Adnexitis, treatment may vary, so the dosage of drugs and the rehabilitation period are determined by the attending physician.

Therapy of the acute form is carried out only in the hospital, includes bed rest and complete rest, if necessary, nursing care is provided. In the first days of hospitalization, a course of treatment with antibiotics and painkillers is prescribed. And also appointed a special diet or fasting, in which you can not eat salty and spicy foods, and minimize the consumption of carbohydrates.

If there is no improvement after 5 days, antibiotics change or prescribe surgery. The operation is called laparoscopy, during which pus is removed from the affected appendages and an antibacterial agent is injected.

Subacute

Treatment of the subacute form of adnexitis is carried out on an outpatient basis with the help of probiotics, anti-inflammatory and antibacterial drugs. The doctor may prescribe immunotherapy to strengthen the woman’s body as a whole and Remens for the treatment of pathology.

Often, swabs with Levomekol or Vishnevsky ointment, which are injected into the vagina at night, as well as douching with the help of Miramistin, are used to quickly relieve pain in the pelvic area.

Chronic

In the chronic form, complex therapy is applied, which includes not only drug treatment, but also physiotherapy (electrophoresis), in addition, Kombilipen is prescribed to strengthen the body's immunity as a whole. Physiotherapy can be carried out in the form of acupressure, which will help eliminate adhesions in the fallopian tubes.

There are complications in the form of uterine fibroids, then absorbable drugs are additionally prescribed, which help to reduce its size. In particularly advanced cases, surgery is performed, which helps to improve the patency of the fallopian tubes or remove the ovaries, if they are completely defeated.

Adnexitis can be successfully treated with homeopathy without antibiotics. For this, it is necessary to consult a homeopath for the selection of individual drugs.

Home treatment

As an addition to the main treatment, you can use herbal remedies for herbs that will help to achieve the maximum result of treatment. If you chose a recipe for yourself. Be sure to consult with the doctor who treats you.

As an anesthetic and anti-inflammatory agent, microclysters of chamomile and hypericum are used. To do this, use the decoction of the plant infused for at least 20 minutes, after which it must be drained and cooled to room temperature. Before the procedure, a cleansing enema is first performed, and then a syringe with chamomile and a hunter is introduced into the anus. A woman should lie on her side until the infusion is fully absorbed. After this procedure, the pain is significantly reduced. The treatment is carried out every evening for 1 week.

Very effective aloe juice with honey to reduce the inflammatory process. Intake is carried out on 1 dessert spoon in the ratio of 1: 1 three times a day before meals. The course of treatment is at least 7 days.

As anti-fever and hemostatic agent can be used infusion of bedstraw. For this you need 2 tsp. crushed plants pour a glass of boiling water and insist 3 hours. It is necessary to accept means hot on a half-glass for time not less than 4 times a day, therefore before each reception it is necessary to heat it. The course of therapy is 20 days.

To relieve inflammation spend syringing boron uterus or wormwood. To do this, make an infusion of herbs for 2 hours, then diluted with boiled water 1: 1 and carry out the procedure. Treatment is 7 days.

As a gentle therapy, you can use sea buckthorn oil tampons, which are inserted into the vagina overnight. It helps relieve pain and inflammation. Repeat the procedure is necessary for 1 week. As such, you can apply and propolis with honey.

During pregnancy

Adnexitis or thrush is most dangerous in the first weeks of pregnancy, so at the first sign of it you should consult a doctor.

Treatment in such cases is carried out in the hospital with antibiotics, which are valid during this period. Lack of timely treatment can have serious consequences for the newborn.

Prevention

To prevent the reappearance of the disease, you must follow the rules:
• use natural cotton linen,
• be protected during sex,
• avoid accidental connections,
• prevent hypothermia,
• to balance physical activities with rest periods,
• engage in sports to strengthen the immune system.

Doctor's advice

As a recommendation after discharge, doctors advise to go to a sanatorium and undergo an additional course of rehabilitation. If mud therapy is not contraindicated, it can strengthen the body and increase the periods of remission in chronic form.

It is also necessary for parents to explain to children, especially girls, how important it is to dress according to the weather and not allow hypothermia, since living healthy is much more exciting. In addition, you need to hold a lecture with the child, which describes the whole danger of the transferred Adnexitis for the female body and how much it costs to make an effort in the end to restore health. If you want to know if you can get thrush from a man, go here.

Adult women are advised to use Kegel exercises or Norbekov exercises to restore their health.

Watch a video about the pelvic floor muscles - why you need to train:

Adnexitis is now considered the most common female disease. The lack of timely treatment very often causes the development of more serious health complications and eventually leads to: aggravation of the adhesions, formation of uterine fibroids and further increase in its size, as well as premature onset of postmenopausal women, endometritis, dysplasia 1,2,3 degrees, nodular fibromyoma and infertility. No need to suffer or search for a solution to the problem on the forums, you need to consult a doctor and undergo a qualitative course of treatment that will help to get rid of the pathology for good.

Adnexitis is a disease that requires mandatory treatment, otherwise very serious consequences may occur.

INFLAMMATORY DISEASES OF UTERINE APPENDAGES

In the structure of gynecological morbidity acute inflammation of the uterus appendages occupy the first place. Isolated tubal inflammation is rare in clinical practice. Most often, women have inflammation of the fallopian tubes and ovaries. It can be combined with inflammation of the uterus. Rarely, according to statistics, there are suppurative processes of the uterus and appendages with possible generalization of the infection.

SALPINGOOFORITE

Salpingo-oophoritis is an infectious-inflammatory process of nonspecific or specific etiology with localization in the fallopian tubes and ovaries. This is the most common inflammatory disease of the pelvic organs.

ICD-10 software code
N70.0 Salpingitis and oophoritis.
N70.1 Chronic salpingitis and oophoritis.
N70.9 Salpingitis and oophoritis, unspecified.

EPIDEMIOLOGY

Isolated inflammation of the various divisions of the pelvis is rare, since anatomically and physiologically they are closely related. In this connection, it is difficult to obtain accurate statistical data on the incidence of salpingoophoritis (as well as on the pathologies of other departments of the small pelvis). Nevertheless, about 40% of patients are hospitalized in hospitals for acute processes or exacerbations of chronic diseases of the genital organs. About 60% of patients turn to antenatal clinic for inflammation. Complications after postponed salpingoophoritis are known.

  • Every fifth woman transferred salpingo-oophoritissuffers from infertility.
  • An ectopic pregnancy occurs 5–10 times more often.
  • In 5–6% of patients, purulent complications occur, requiring inpatient treatment and surgery (often with removal of the fallopian tubes).

The adhesions process (a consequence of chronic inflammatory diseases) leads to anatomical disorders and pelvic pain, which can affect the sphere of sexual relations.

ANAMNESIS AND PHYSICAL RESEARCH

In acute inflammation, a bimanual examination is always painful (especially the area of ​​the appendages), as this involves the pelvic peritoneum (sometimes with irritation symptoms). In the chronic process, on the contrary, hardening and fibrosis of the fallopian tubes with the formation of adhesions in the small pelvis make the appendages inactive. Often determine their pain.

LABORATORY RESEARCH

In the acute process there are no specific changes in the analyzes (moderate leukocytosis with a shift to the left, an increase in the ESR), and in the case of the chronic, only an increase in the ESR is often found. Bacterioscopic and bacteriological studies of material from the cervical canal, vagina and urethra are of primary importance. The goal is to identify pathogens and determine their sensitivity to antibiotics.

TOOL RESEARCH

The echographic method does not give clear information about acute salpingoophoritis. You can diagnose only the thickening of the fallopian tubes, adhesions in the pelvis. With pelvioperitonite, a small amount of fluid accumulates in the Douglas pocket. You can also determine the tumor form with hydrosalpinx or pyosalpinx.

It is better to use ultrasound with a vaginal sensor. CT or MRI may be used, especially in differential diagnosis with ovarian tumors.

DIFFERENTIAL DIAGNOSTICS

Acute salpingo-oophoritis is often necessary to differentiate from acute surgical pathologies (acute appendicitis, surgical peritonitis, intestinal tumors, intestinal or renal colic). At the same time, the use of laparoscopy allows you to carry out an early topical diagnosis and choose the right treatment strategy.

INDICATIONS TO CONSULTATION OF OTHER SPECIALISTS

Consultations of the surgeon and urologist are often urgently needed, especially in urgent cases of differential diagnosis.

EXAMPLE OF FORMULATION OF DIAGNOSIS

Exacerbation of chronic bilateral salpingoophoritis with the formation of the right-sided hydrosalpinx and adhesions in the pelvis.

TREATMENT OF SALPINGITA, ADNEXIT, SALPINGOOFORITA

AIMS OF TREATMENT

  • Relief of acute salpingoophoritis or exacerbation of chronic.
  • Clinical and laboratory examination.

ПОКАЗАНИЯ К ГОСПИТАЛИЗАЦИИ

Всегда есть при остром процессе или обострении хронического.

NON-MEDICATED TREATMENT OF SALPINGITIS, ADNEXIT, SALPINGOOFORITA

Practice in the chronic process or in the period of post-hospital rehabilitation in the acute process. Physiotherapeutic methods are mainly used: UHF, magnetic therapy, electrophoresis with zinc, magnesium, hyaluronidase, etc., diadynamic currents, sanatorium treatment (radon baths and irrigation, thalassotherapy).

MEDICAL TREATMENT OF SALPINGITIS, ADNEXIT, SALPINGOOFORITA

Fundamental in the treatment is antibiotic therapy, which is appointed empirically, taking into account the most likely pathogens. Modes of PID antibacterial therapy should ensure the elimination of a wide range of pathogens (see the section “The etiology of PID). The first-line regimens include a combination of 3rd generation cephalosporins (cefotaxime, ceftriacon) with metronidazole, the administration of inhibitor-protected aminopenicillins (amoxicillin / clavulanic acid, etc.); as an alternative regimen, lincosamides can be used in combination with the IIIIII generation aminoglycosides, fluoroquinolone. with metronidazole, carbapenems. Given the high risk of chlamydial infection, patients are simultaneously indicated that doxycycline or macrolides are prescribed.

Antibacterial therapy for PID usually begins with the intravenous administration of drugs with the subsequent transition to their oral administration (step therapy). In case of mild forms of PID, patients are treated on an outpatient basis, in this case, oral medications with high bioavailability are preferred. Antibiotics are combined with detoxification therapy: saline solutions, 5% glucose solution ©, reopolyglukine ©, hemodez ©, polydez ©, mafusol, injectant solution is administered intravenously. , protein preparations, etc.

According to the indications prescribed analgesics, local anti-inflammatory drugs in the form of candles, ice on the stomach. When stabilizing the general condition and subsiding of the acute process, phonophoresis with calcium, copper or magnesium is carried out (according to the cycle).

SURGICAL TREATMENT OF SALPINGITIS, ADNEXIT, SALPINGOOFORITA

At the initial stage, diagnostic laparoscopy is used. In acute inflammatory process, it is advisable to enter into the abdominal cavity a solution of antibiotics (ampicillin 1 g per 20 ml of saline). In the future, surgical treatment is resorted to in the absence of the effect of conservative drug therapy and the formation of purulent tubo-ovarian formations.

INDICATIONS TO CONSULTATION OF OTHER SPECIALISTS

Consultation of specialists (surgeon, urologist) is shown:

  • in the first stage - for differential diagnosis,
  • in the course of treatment - in the absence of the effect of treatment or the appearance of a combined symptom associated with the pathology of other organs.

PATIENT INFORMATION

The patient must necessarily complete the full course of anti-inflammatory treatment of the acute process or exacerbation of the chronic. It is necessary to conduct courses of anti-relapse treatment, use spa balneotherapy, use contraceptive methods. If an STI is found at a partner, treat it and conduct a control examination of the couple.

For life - favorable. Problems usually arise from menstrual, sexual and reproductive function.

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