Salpingo-oophoritis (adnexitis) is an inflammation of the uterus appendages (tube, ovary, ligaments), occurs ascending or descending secondarily from inflammatory-altered abdominal organs (for example, with appendicitis) or hematogenous. With upward infection, microorganisms penetrate from the uterus into the lumen of the fallopian tube, involving all layers (salpingitis) in the inflammatory process, and then in half of the patients, the ovary (oophoritis) together with the ligamentous apparatus (adnexitis, salpingoophoritis). The leading role in the occurrence of adnexitis belongs to chlamydial and gonococcal infection. Inflammatory exudate, accumulating in the lumen of the fallopian tube, can lead to an adhesive process and closure of the fimbrial region. There are saccular formations of the fallopian tubes (saktosalpinksy). The accumulation of pus in the pipe leads to the formation of pyosalpinx, serous exudate – to the formation of hydrosalpinx.
When microorganisms penetrate the tissue of the ovary, purulent cavities (ovarian abscess) can form in it, at the merging of which ovarian tissue melts. The ovary is transformed into a saccular formation, filled with pus.
One of the complications of acute adnexitis is tubo-ovarian abscess, resulting from the melting of the contiguous walls of pyovar and pyosalpinx.
Under certain conditions, through the fimbrial section of the tube, as well as as a result of rupture of an ovarian abscess, pyosalpinx, tubo-ovarian abscess, the infection can penetrate into the abdominal cavity and cause inflammation of the pelvic peritoneum (pelvioperitonitis), and then other floors of the abdominal cavity (peritonitis) with the development of abscesses of the rectal pelvic peritoneum (pelvioperitonitis), and then other floors of the abdominal cavity (peritonitis) with the development of abscesses of the rectal pelvic peritoneum (pelvioperitonitis), and then other floors of the abdominal cavity (peritonitis) with the development of abscesses of rectal ovarian cavity dimples, inter-intestinal abscesses.
The disease most often occurs in women of early reproductive period, leading active sex life.
Clinical symptoms of acute salpingoophoritis (adnexitis) include abdominal pain of varying intensity, increased body temperature to 38–40 ° C, chills, nausea, sometimes vomiting, purulent discharge from the genital tract, dysuric phenomena. The severity of clinical symptoms is due, on the one hand, to the virulence of the pathogens, and on the other, to the reactivity of the microorganism.
During a general examination, the tongue is wet, coated with white blotch. Palpation of the abdomen can be painful in the hypogastric region. Gynecological examination reveals purulent or sullionous purulent discharge from the cervical canal, thickened, “swollen, painful appendages of the uterus. When forming piosalpinks, pyovar, tubo-ovarian abscesses in the area of the uterus or posterior to the uterus, immobile, voluminous, painful formations without clear contours, uneven consistency can be determined, often constituting a single conglomerate with the body of the uterus. In the peripheral blood, leukocytosis, leukocyte shift to the left, increased ESR, C-reactive protein level, dysproteinaemia are detected. In the analysis of urine possible increase in protein, leukocyturia, bacteriuria, which is associated with damage to the urethra and bladder. Sometimes the clinical picture of acute adnexitis is erased, but there are pronounced destructive changes in the appendages of the uterus.
Bacterioscopy of smears from the vagina and the cervical canal reveals an increase in the number of leukocytes, cocci flora, gonococci, trichomonads, pseudomycelium, and spores of a yeast-like fungus. The bacteriological study of secretions from the cervical canal does not always allow the detection of the adnexitis pathogen. Microbiological examination of the contents of the fallopian tubes and the abdominal cavity, obtained by laparoscopy, laparotomy or puncture, provides more accurate results.
With ultrasound scanning, dilated uterine tubes, free fluid in the small pelvis (inflammatory exudate) can be visualized. The value of ultrasound increases with the formation of inflammatory tubo-ovarian formations of irregular shape, with fuzzy contours and heterogeneous echostructure. Free fluid in the pelvis often indicates rupture of a purulent formation of uterine appendages.
In the diagnosis of acute adnexitis, laparoscopy is the most informative. It allows you to determine the inflammatory process of the uterus and appendages, its severity and prevalence, to conduct a differential diagnosis of diseases accompanied by a picture of “acute abdomen”, to determine the correct tactics. In acute salpingitis, endoscopically edematous hyperemic fallopian tubes, outflow of serous-purulent or purulent exudate from the fimbrial regions and its accumulation in the rectovaginal cavity are detected. The ovaries may be enlarged as a result of secondary involvement in the inflammatory process. Pyosalpinx is visualized as a retort-like thickening of the tube in the ampullary section, the walls of the tube are thickened, swollen, compacted, the fimbrial section is sealed, and there is pus in the lumen. Piovar looks like an ovarian volume formation with a purulent cavity that has a dense capsule and fibrin overlay. During the formation of tubo-ovarian abscess, extensive adhesions form between the tube, ovary, uterus, intestinal loops, pelvic wall. The long existence of tubo-ovarian abscess leads to the formation of a dense capsule, delimiting the purulent cavity (cavity) from the surrounding tissues. When such purulent formations rupture, there is a perforation on their surface, from which pus enters the abdominal cavity. These changes in the internal genital organs, detected during laparoscopy in case of acute inflammation of the uterine appendages, can also be noted in the chest section, which is performed in order to remove the source of inflammation. Obtaining purulent contents from the mass of the uterine appendages when they are punctured through the posterior vaginal fornix under ultrasound control also indirectly confirms the inflammatory nature of the disease.