Chronic salpingo-oophoritis (adnexitis) is a consequence of acute or subacute inflammation of the uterus. The reasons for the chronization of the inflammatory process include inadequate treatment of acute adnexitis, reduced body reactivity, properties of the pathogen. Chronic salpingo-oophoritis is accompanied by the development of inflammatory infiltrates, connective tissue in the wall of the fallopian tubes and the formation of hydrosalpinxes. Dystrophic changes occur in the ovarian tissue, microcirculation is impaired due to the narrowing of the lumen of the blood vessels, resulting in reduced synthesis of sex steroid hormones. The result of acute or subacute inflammation of the uterus appendages becomes the adhesive process in the small pelvis between the tube, ovary, uterus, pelvic wall, bladder, omentum and intestinal loops. The disease has a protracted course with occasional exacerbations.
Patients complain of dull, aching pain in the lower abdomen of varying intensity. Pain may radiate to the lower back, rectum, thigh, i.e. along the pelvic plexus, and accompanied by psycho-emotional (irritability, nervousness, insomnia, depressive states) and autonomic disorders. Pains aggravated after hypothermia, stress, menstruation. In addition, in chronic salpingo-oophoritis, menstrual dysfunction is observed in the form of menometrorrhagia, opso- and oligomenorrhea, premenstrual syndrome, caused by anovulation or insufficiency of the corpus luteum. Infertility in chronic adnexitis is explained both by a violation of steroidogenesis in the ovaries and by tubo-peritoneal factor. The adhesions process in the uterus can cause an ectopic pregnancy. Frequent exacerbations of the disease lead to sexual disorders – decrease in libido, dyspareunia.
Exacerbations of chronic adnexitis occur due to increased pathogenic properties of the pathogen, reinfection, reduced immunobiological properties of the microorganism. During exacerbation, pain increases, the general state of health is disturbed, body temperature may rise, purulent discharge from the genital tract is noted. An objective study reveals inflammatory changes in the uterus appendages of varying severity.
Diagnosis of chronic salpingoophoritis is extremely difficult because chronic pelvic pains with periodic intensification are also found in other diseases (endometriosis, cysts and tumors of the ovary, colitis, pelvic plexitis). Some information to suspect chronic inflammation of the uterine appendages, can be obtained by bimanual examination of the pelvic organs, ultrasound of the pelvic organs, hysterosalpingography and GHA. A gynecological examination can determine the limited mobility of the uterus (adhesions), the formation of an elongated shape in the region of the uterine appendages (hydrosalpinx). Ultrasound scanning is effective in diagnosing the lesions of the uterine appendages. Hysterosalpingography and GHA help to identify adhesions in tubal-peritoneal infertility factor (accumulation of a contrast agent in closed cavities). Currently, hysterosalpingography is used less and less often due to the large number of diagnostic errors in the interpretation of X-ray images.
With a long course of the disease with occasional lower abdominal pain, with the ineffectiveness of antibiotic therapy, laparoscopy should be used, which allows one to visually determine the presence or absence of signs of chronic adnexitis. These include adhesions in the pelvis, hydrosalpinxes. The consequences of acute salpingoophoritis, often of gonorrheal or chlamydial etiology, consider adhesions between the surface of the liver and the diaphragm — Fitz-Hugh syndrome — Curtis.
Pelvioperitonitis (inflammation of the peritoneum of the small pelvis) occurs a second time when pathogens from the uterus or its appendages penetrate the pelvic cavity. Depending on the pathological contents in the pelvis there are serous-fibrinous and purulent pelvioperitonitis. The disease begins acutely, with the appearance of sharp pains in the lower abdomen, an increase in body temperature to 39–40 ° C, —consciousness, nausea, vomiting, and loose stools. During the physical examination, a moist, white-coated tongue attracts attention. The abdomen is swollen, takes part in the act of breathing, is painful in the lower parts of palpation; there, in varying degrees, a symptom of irritation of the peritoneum of Shchetkin-Blumberg is expressed, the tension of the anterior abdominal wall is noted. Palpation of the uterus and appendages during gynecological examination is difficult due to the sharp pain, the posterior vaginal fornix is flattened due to the accumulation of exudate in the rectovaginal deepening. Changes in the clinical analysis of blood characteristic of inflammation. From additional diagnostic methods, one should point out transvaginal ultrasound scanning, which helps to clarify the condition of the uterus and appendages, determine free fluid (pus) in the pelvis. The most informative diagnostic method is laparoscopy: visualization of the pelvic peritoneum hyperemia and adjacent intestinal loops with the presence of purulent contents in the rectovaginal cavity. As the acute phenomena subside as a result of the formation of adhesions of the uterus and appendages with the omentum, intestine, bladder, inflammation is localized in the pelvic region. When puncture the abdominal cavity through the posterior vaginal fornix, inflammatory exudate can be aspirated. Carry out bacteriological analysis of the material obtained.