Chronic salpingo-oophoritis

Introduction to chronic tubal oophoritis In the acute phase of tubal oophoritis, if the treatment is delayed or incomplete, it will become chronic after prolonged prolongation. In a small number of cases, the pathogenic bacteria have weak virulence, or the machine has strong resistance, and there is no obvious symptom, so it does not cause attention, or is misdiagnosed and delays the treatment. However, in the case that many powerful antibiotics are effective enough to treat acute tubal oophoritis, the possibility of acute conversion to chronic lesions has been greatly reduced. Only tuberculosis infections are generally chronic disease processes. Gynecological examination shows that the cervix has many erosions, valgus, mucus purulent leucorrhea, uterus often backward or backward flexion, activity is worse than normal, generally moving the cervix or palace body pain, mildly only in bilateral attachments At the site of the thickening of the fallopian tube; in severe cases, the size of the pelvic cavity or the posterior side of the uterus can be found in different sizes, irregular and fixed mass, more tenderness, thick and sticky walls, severe cystic Most of the masses are abscesses; the wall is thin, the tension is large and the person is slightly active, mostly hydrosalpinx. basic knowledge The proportion of illness: 0.0025% Susceptible people: women Mode of infection: non-infectious Complications: ectopic pregnancy infertility

Causes of chronic fallopian tube oophoritis

The type of lesions of chronic tubal oophoritis can be roughly divided into four types: hydrosalpinx, tubal empyema, accessory inflammatory mass and interstitial salpingitis.

(1) Hydrosalpinx and tubal ovarian cysts: (Hydrosalpinx and tuboovarian cyst): Fallopian tube hydrops endometritis causes umbrella end latching, exudate accumulates in the lumen, and some are tubal empyema, part Long-term pus absorption and liquefaction, in the form of serous, evolved into hydrosalpinx, such as the fallopian tube ovarian abscess, the formation of fallopian tube ovarian cysts (water), in addition, sometimes due to ovarian inflammation caused by follicular rupture blocked the formation of follicular cysts, or When the follicle ruptures, the bacteria enters into the gap to form an inflammatory effusion. Later, it forms a fallopian tube ovarian cyst with the oviduct. The tubal water is often not very large, all of which are below 15cm in diameter, and the ampulla is the same as the fallopian tube. The shape of the oviduct can be up to 10~20cm in diameter. Both of them are seen in cases where the inflammation has not recurred for many years. The appearance is smooth, the wall of the tube is thin and translucent due to swelling, and the tubal hydrops usually have a fine membrane-like cord and pelvic peritoneal adhesion. However, the individual is free, because the distal enlargement is heavier, and even the proximal end (isthmus) is the axis, and the hydrosalpinx is reversed (Fig. 1). More common in the side, the hydrosalpinx is often bilateral, and its uterus is sometimes only loose and occluded. Therefore, when the uterine tubal iodine angiography, X-ray or radiograph can show the typical image of tubal water; a few cases claim Occasionally, a large amount of intermittent or intermittent small amount of water is discharged from the vagina. It may be caused by an increase in the pressure in the hydrosalpinx. The effusion is caused by a loosely occluded fallopian tube. After a large number of vaginal discharges, the pelvic examination can reveal the original. Some of the blocks disappeared.

(B) fallopian tube empyema, fallopian tube ovarian abscess: (pyosalpinx and tubo-ovarian abscess): tubal empyema for a long time, can be repeated acute attacks, especially in close contact with the pelvic intestinal tube, E. coli infiltration and secondary mixed infection, When the body's resistance is weakened, the remaining fallopian tube empyema can also be stimulated by the outside world, such as overworked, sexual life, gynecological examination, etc., and acute recurrence due to local congestion before and after menstruation, due to recurrent episodes, the height of the fallopian tube wall Fibrosis and thickening, and adhesion to its adjacent organs (uterus, posterior lobe of the broad ligament, sigmoid colon, small intestine, rectum, pelvic floor or pelvis sidewall), if stabilized after treatment, the pus is liquefied to form tubal hydrops, It can become increasingly viscous and is gradually replaced by granulation tissue, and occasionally calcification or cholesterol stones can be found.

(3) Adenexitis: a chronic tubal ovarian inflammation, which can form inflammatory fibrosis and form a relatively solid inflammatory mass, generally smaller, such as with the intestine, omentum, uterus, pelvic peritoneum, bladder, etc. Adhesive, can form a large mass, the mass can also be formed after the operation of pelvic inflammation, at this time with the preserved organs, such as the ovary or part of the fallopian tube, the pelvic connective tissue or the sub-lust stump, the intestine, the omentum If it has become a chronic inflammation block, it is more difficult to completely dissipate the inflammation or completely disappear the mass.

(D) chronic interstitial salpingitis (chronic interstitial salpingitis): chronic inflammatory lesions left by acute interstitial salpingitis, and chronic oophoritis coexist, showing bilateral tubal thickening, fibrosis, in its muscle layer There may be small pus residuals in the peritoneum. The clinical manifestations are thickening of the attachment or thickening of the cord. Microscopic examination of the fallopian tubes has lymphocytes and extensive infiltration of plasma cells. In addition, a nodular nodular salpingitis can be formed. It is a residual of chronic inflammatory lesions of the fallopian tube. The lesions are mainly confined to the isthmus of the fallopian tube. In these cases, obvious nodules appear in the isthmus, and the nodules may sometimes be large. The fibroids resembling the uterine horns, the abnormal thickness of the muscle layer in the microscopic examination. Endometrial folds can be involved in the muscle layer, which resembles endometriosis, which can be distinguished by the lack of endometrial stroma. Individual muscle layers have lymphocytes and plasma cells infiltrated.

Chronic fallopian tube ovarian inflammation prevention

Active and thorough treatment of acute tubal oophoritis, pelvic peritonitis, is the key to prevent the occurrence of this disease, such as already suffering from this disease, should be actively treated with the doctor, and to persevere, so as not to delay the disease for a long time, difficult to cure, usually should pay attention Personal hygiene and menstrual period to prevent chronic infection. In addition, because the disease is stubborn and recurrent, it often makes the patient's mental burden heavier. Therefore, it is necessary to establish the confidence that the patient must win, maintain a comfortable mood, actively exercise, and enhance physical fitness. To improve disease resistance.

Chronic fallopian tube oophoritis complications Complications, ectopic pregnancy, infertility

In ectopic pregnancy, the fallopian tube can cause adhesions due to inflammation, stagnant water or empyema, and both sides can cause infertility.

Chronic fallopian tube ovarian symptoms Common symptoms Abdominal pain Dysmenorrhea Ovarian dysfunction Urinary cystic mass Sexual intercourse Pain Abscess Depression

In the case of acute pelvic genital inflammation, the above symptoms can be considered as chronic attachment inflammation. Even if there is no acute history, the above-mentioned series of symptoms can be highly suspected. For example, only the para-uterine tissue is slightly thickened without a mass. Then you can carry out the tubal fluid examination, such as the tubal failure, chronic tubal fluid examination, such as the proven fallopian tube, the diagnosis of chronic salpingitis can be basically established.

(1) Abdominal pain: There are different degrees of pain in the lower abdomen, mostly hidden discomfort, soreness in the lower back and ankle, swelling, falling feeling, often aggravated by fatigue, due to pelvic adhesions, there may be bladder, rectal filling pain or platoon Pain in the air, or other symptoms of bladder rectal irritation, such as frequent urination, heavy and heavy.

(2) irregular menstruation: with frequent menstruation, excessive menstrual flow is the most common, may be the result of pelvic congestion and ovarian dysfunction, due to chronic inflammation leading to uterine fibrosis, uterine insufficiency or adhesion caused by abnormal uterine position Etc., can cause more menstruation.

(3) Infertility: The fallopian tube itself is invaded by the disease, forming a blockage and causing infertility, and it is more common to have infertility.

(D) dysmenorrhea: due to pelvic congestion caused by blood stasis dysmenorrhea, mostly in the first week before menstruation, there is abdominal pain, the closer to the menstrual period, the more severe, until menstrual cramps.

(5) Others: such as increased vaginal discharge, painful intercourse, gastrointestinal disorders, fatigue, labor affected or insufficiency, mental and neurological symptoms and depression.

(6) Signs:

1. Abdominal examination: There are few other positive findings except for mild tenderness on the lower abdomen.

2, gynecological examination: the cervix is more erosive, valgus, mucus purulent vaginal discharge, the uterus often backward or hindered, the activity is worse than normal, generally moving the cervix or palace body pain, mildness is only in double The side attachments are thickened with a cord-shaped fallopian tube; in severe cases, they can be squashed on both sides of the pelvis or on the posterior side of the uterus. Irregular and fixed masses, tenderness, thick and sticky walls, severe Most of the cystic masses are abscesses; those with thin walls, large tension and slightly active, mostly hydrosalpinx.

Chronic fallopian tube oophoritis

1. Abdominal examination: There are few other positive findings except for mild tenderness on the lower abdomen.

2, gynecological examination: the cervix is more erosive, valgus, mucus purulent vaginal discharge, the uterus often backward or hindered, the activity is worse than normal, generally moving the cervix or palace body pain, mildness is only in double The side attachments are thickened with a cord-shaped fallopian tube; in severe cases, they can be squashed on both sides of the pelvis or on the posterior side of the uterus. Irregular and fixed masses, tenderness, thick and sticky walls, severe Most of the cystic masses are abscesses; those with thin walls, large tension and slightly active, mostly hydrosalpinx.

Diagnosis and diagnosis of chronic fallopian tube oophoritis

Differential diagnosis

(1) Identification with old ectopic pregnancy: The history of the two is different. Older ectopic pregnancy often has short-term delay of menstruation, sudden lower abdominal pain, accompanied by nausea, dizziness and even syncope and other symptoms of internal bleeding, can be reduced by themselves, or even return to normal life, and later There are repeated sudden abdominal pains, there are hidden pain and falling feeling after the attack, consciously have a mass in the lower abdomen, a small amount of bleeding in the vagina, etc., are different from chronic annexitis, and have anemia, double diagnosis, package The block is mostly on one side, it is solid and elastic, the shape is extremely irregular, and the tenderness is lighter than inflammation. It can be diagnosed by sucking out old blood or small blood clot through the posterior malleolus.

(B) identification with endometriosis: sometimes difficult to identify, due to common dysmenorrhea, menstruation, sexual intercourse pain, bowel pain, infertility and pelvic mass, adhesions and other signs easily confused, carefully asked about the history, the uterus The dysmenorrhea of membrane ectopic disease is progressive and more and more intense. Before the menstrual period, the menstrual period is intense and lasts until several days after menstruation. Most of them are primary infertility, no vaginal discharge and inflammatory history, and the double-diagnosis attachment is thickened. Adhesion to the posterior wall of the posterior uterus, such as the uterine ligament ligaments are easy to diagnose, the amount is often lack of this sign, can be through hysterosalpingography or laparoscopy to get a correct diagnosis.

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