Chronic bilateral salpingitis: symptoms and treatment. Symptoms and treatment of left-sided salpingitis

Salpingitis is a disease that is accompanied by pronounced inflammation in the tissues fallopian tube. Pathology rarely occurs in isolation and is mainly combined with adnexitis and infectious pathologies in other organs of the female reproductive system. The process can be both acute and protracted. Chronic salpingitis is one of the most common causes of female infertility. In addition, the disease can be localized in one fallopian tube (unilateral salpingitis) or in both at once (bilateral salpingitis).

The inflammatory process begins with the penetration of infectious agents into the fallopian tube. Due to the development of inflammation, the fallopian tubes become filled with blood and swell. In the future, regression of the process or its transition to a chronic form may occur. After inflammation subsides in fallopian tubes ah, a viscous secretion is released, which helps to block their lumen, which becomes main reason infertility. In chronic cases, adhesions form in the pipes, which are not always possible to get rid of even surgically.

The causes of salpingitis are infectious agents, often of a bacterial nature, penetrating the fallopian tubes in different ways. The main ways the pathogen enters the fallopian tubes are:

1. Ascending (through the vagina and uterus);
2. Descending (through the intestines (appendix - on the right, sigmoid - on the left);
3. Hematogenous or lymphogenous route (from any organ);
4. Due to surgical procedures (in particular, abortions, especially clandestine ones).

Based on the nature of the infectious agent, salpingitis is divided into specific and nonspecific. The latter appears due to the entry into the fallopian tube of microorganisms of an opportunistic nature, for example, E. coli, staphylococci, candida fungus, streptococci and others. Specific salpingitis occurs when the following types of infectious agents are ingested:

• Tuberculosis bacillus;
• Chlamydia;
• Trichomonas;
• Gonococcus.

Except immediate causes, leading to the appearance of salpingitis, there are also risk factors, the impact of which increases the likelihood of infection (in particular, of a nonspecific nature):

1. Decreased immunity;
2. Pathologies of the genital organs (not inflammatory in nature, for example, ovarian hypoplasia);
3. Traumatic injuries due to labor;
4. Medical manipulations related to the uterus (in particular, curettage, installation or removal of intrauterine devices).

Clinical picture

Signs of salpingitis in the acute and chronic stages will be different. In advanced cases, clinical picture becomes blurred, activating only during exacerbations. The main symptom of salpingitis chronic course is infertility. In the acute phase, the following symptoms are distinguished:

• Pain in the lower abdomen (if left-sided salpingitis - on the left, if right-sided - on the right, in the middle the pain will be localized with bilateral damage);
• Pain may radiate to the leg or lumbar region;
• Vaginal discharge (character, smell and abundance depend on the causative agent of the infection);
• Pain and burning sensation during urination;
• Unpleasant sensations (usually painful) during and after sex;
• General signs of the inflammatory process (fever, weakness, etc.);
• Gastrointestinal disorders (nausea leading to vomiting, diarrhea);
• Various irregularities in the menstrual cycle (also typical for chronic process and are manifested by delayed menstruation, discharge mixed with blood outside of menstruation, as well as spontaneous uterine bleeding).

Whenever similar symptoms, or even better much earlier, when inflammation begins in the vagina, you should immediately consult a doctor.

Separately, the following symptoms of salpingitis in women are distinguished:

1. Hydrosalpinx. This process is characterized by the accumulation of viscous fluid in the lumen of the fallopian tubes, which subsequently becomes the main cause of infertility.
2. Pyosalpinx. This concept characterizes purulent salpingitis and implies the accumulation of pus in the lumen of the fallopian tube. This condition is life-threatening, since when the wall of the fallopian tube melts, purulent contents pour into the peritoneal cavity, and peritonitis occurs.

With the specific nature of the lesion, additional symptoms may appear that are characteristic only of a specific infectious agent. For example, gonorrheal salpingitis is characterized by generalization of the process not only in the reproductive system, but also in the urinary system, as well as in the rectum. Chlamydial infection, on the contrary, is erased, practically asymptomatic, but such an infection is much more difficult to treat.

Consequences and complications of the disease

If symptoms of salpingitis are not detected and treated in a timely manner wrong medications complications may occur of this disease. These include:

• Oophoritis. The concept is characterized by the spread of infection to the ovaries. Very common complication, and salpingitis rarely occurs in isolation without it.
• Tuboovarian abscess. An inflammatory process in the fallopian tube and ovary (or both at once) of a purulent nature. The condition is a direct indication for a woman’s hospitalization and requires immediate treatment, as it can cause sepsis or peritonitis.

Long-term complications (consequences of salpingitis that do not appear immediately):

1. Pain in the pelvic area. Practically 25% women Those who have been ill and even completely recovered from salpingitis periodically experience pain in the lower abdomen. Its appearance is especially typical during sex, and there is also a connection between pain and the menstrual cycle.
2. Infertility. The inability to have a child is associated with obstruction of the fallopian tubes. TO this state most often results in chronic bilateral salpingitis.
3. Ectopic pregnancy. At partial preservation the lumen of the fallopian tube may interfere with the passage and attachment of the fertilized egg in the uterus. Due to the fact that the fetus begins to develop in the tube itself, it can rupture, which poses a high danger to life.

Diagnostics

To diagnose salpingitis, it is carried out comprehensive examination patients. It includes:

• Inspection. There is severe pain during the examination. You can also palpate to determine the presence of an inflammatory infiltrate in the area of ​​the fallopian tubes. A decrease in tubal mobility is noted in the chronic phase of the disease.
• Clinical blood test. With salpingitis, general inflammatory signs, which include increase in ESR and leukocytosis.
• Microscopy. Examination of smears under a microscope to identify a bacterial pathogen.
• Sowing on a culture medium. It also allows you to identify the pathogen and conduct a sensitivity test to antibiotics, which will help in further treatment.
• ELISA and PCP. These methods are highly specific and suitable for difficult-to-diagnose pathogens. These include chlamydia, tubercle bacilli and gonococci.
• Ultrasound diagnostics. Allows you to visually assess the condition of the affected organ, and in the chronic phase, the degree of obstruction.
• Laparoscopy. Allows direct access to the fallopian tubes through an incision in the abdominal cavity. The research method is highly informative, but is used only when severe course pathology, as it is difficult to implement and expensive.

Treatment

Treatment for salpingitis will vary depending on the stage of the disease. Treating yourself or using folk remedies is strictly contraindicated, as you can start the process so much that life-threatening complications or incurable infertility arise. Therapy for the acute phase of pathology includes:

1. Stationary regime, which consists of complete rest and limitation of physical activity.
2. A gentle diet.
3. Etiological drug treatment (often these are antibacterial agents, against protozoa - Metronidazole, fungal infection are being treated antifungal agents). The course of therapy is approximately two weeks, but can be shortened or lengthened depending on the severity of the disease.
4. Pathogenetic therapy includes non-steroidal anti-inflammatory drugs, cocarboxylase, autohemotherapy.
5. Treatment of salpingitis with antibiotics requires the additional administration of probiotics that restore the microflora.

When the severity of the process subsides, as well as for treatment chronic phase diseases, physiotherapeutic procedures are used:

• Ultrasound;
• Acupuncture;
• Electrophoresis;
• Water treatment;
• Magnetotherapy;
• Heat treatment.

All methods are aimed at eliminating, which will improve the patency of the fallopian tubes. The therapy is also aimed at relieving pain, which bothers many patients even after recovery. Surgical interventions are also used in the treatment of salpingitis. The decision to schedule an operation is made individually, since the main factor is the woman’s desire to have a child. Direct indication to surgical intervention The appearance of neoplasms in the fallopian tube is considered.

The standard operation for salpingitis is laparoscopy. It allows you to cope with any type of pathology in the fallopian tubes, leaves no scars, does not cause complications and has a short recovery period. Within a few days after this therapy, a woman can be discharged from the hospital, and after a few months (preferably six months) plan a pregnancy.

Specific infectious inflammation fallopian tubes, otherwise called salpingitis, is a fairly common disease and, alas, very unpleasant. Even with timely treatment, when a woman immediately consults a doctor when the first symptoms appear, she will have to go through far from the most painless procedures, which, however, most often ends in complete recovery. But often ladies prefer to ignore the signals sent by the body (everyone tolerates it - and I will tolerate it). But the “policy of non-interference” will not lead to anything good, and instead of a conservative drug treatment the patient may end up on the operating table.

We would like to immediately reassure particularly suspicious ladies: the likelihood that the situation will develop according to worst case scenario, is quite small, so you should not take the diagnosis of “salpingitis” so sharply. This, let us clarify once again, is exactly the diagnosis! But to think about what you need to pay close attention to when certain symptoms appear, believe me, it makes sense. This will allow you to seek qualified help in time and minimize potential risk. Even in this case, a woman will have to take serious care of her health, but, really, this is much better than memorizing the surgeon’s phone number. This is what we will talk about today.

Scheme of the course of salpingitis

Those who consider themselves “savvy” in matters of medicine will find it useful to know that, contrary to popular belief, inflammation of the fallopian tubes is initial stages sometimes it can be practically asymptomatic. And if so, then the absence of a clearly expressed pain syndrome in the presence of several vague manifestations of the disease does not mean that you do not have salpingitis. Only a qualified doctor can confirm or deny the presence of inflammation!

Nonspecific symptoms of salpingitis

1. Sudden and sharp increase temperatures (often up to 40 degrees and above).
2. Severe chills that occur even in the warm season, which, however, are not accompanied by signs of a cold (no cough or runny nose).
3. Problems with urination ( frequent urge, pain). They can be easily confused with banal cystitis and you can try to “cure” yourself, significantly complicating the subsequent treatment of salpingitis itself.
4. Unpleasant sensations during sex.
5. Failure of the menstrual cycle (discharge is either too heavy or too scanty).
6. Effects from the outside gastrointestinal tract(practically complete absence loss of appetite, nausea, vomiting, feeling of heaviness, flatulence, frustration, sometimes heartburn).
7. Grayish-white vaginal discharge in the absence of any known genitourinary problems.
8. “Penduldulum” pain in the lower abdomen, which appears and then disappears.
9. Fatigue, decreased performance, depressed mood.

Symptoms of acute salpingitis

Most often, they are clearly expressed and do not present any difficulties for diagnosis. True, upon superficial examination they can be confused with manifestations acute poisoning or the same appendicitis, so when talking with your doctor, try to remember everything that bothers you in one way or another.

1. An unprovoked increase in temperature to 37.5–39 degrees, accompanied by weakness, chills, malaise and increased heartbeat. By the way, it is believed that each “additional” degree increases the heart rate (heart rate) by 7-10 beats per minute.
2. Severe pain in the groin area.
3. Obvious signs of damage to the gastrointestinal tract and genitourinary system. The reason for this “promiscuity” of salpingitis is that the development of the inflammatory process leads to enlargement and swelling of the fallopian tubes, which because of this begin to put pressure on the surrounding tissues, and the resulting pain begins to radiate to the rectum and tailbone.
4. Abnormal vaginal discharge (purulent, foamy, or even bloody, depending on the type of pathogen).

Symptoms of chronic (sluggish) salpingitis

Manifestations are often blurred and implicit, and the patient’s general condition is satisfactory or even good. The most important diagnostic criterion– temperature – in in this case turns out to be uninformative, and 36.9–37.2 degrees (that is, the low-grade threshold) few doctors general practice considers it a sufficient basis for an additional in-depth examination.

One of the few visible manifestations of chronic salpingitis is certain menstrual irregularities. Painful or scanty periods (in other words, algomenorrhea and menstruation) are unlikely to add Have a good mood, and in the absence of adequate therapy) may well lead to infertility.

Symptoms of left-sided salpingitis

The external manifestations of this subspecies are not much different from the classic ones (we talked about them earlier), therefore only a qualified doctor can determine the presence of the disease. gynecological examination. Characteristic signs left-sided salpingitis - swelling of the mucous membrane of the fallopian tube, ulceration of their surface layer, the formation of a cavity filled with mucus, pus and/or blood.

Symptoms of right-sided salpingitis

Due to some features anatomical structure In women, it can be easily confused with appendicitis, and the existing signs of the disease are associated with damage to muscle tissue, swelling and formation. In other words, to determine the presence of right-sided salpingitis based only on external manifestations, almost impossible.

The name of the disease comes from the Greek “salpingos” - trumpet. With this pathology, inflammation occurs in the fallopian tubes, which connect the body of the uterus to the ovaries. Most often, the infection occurs in an ascending manner - pathogens spread from the uterus to the tubes, involving them in the inflammatory process.

Less commonly, downward spread occurs - in this case, pathogenic agents enter the fallopian tube from nearby parts of the intestine. It is also possible for the infection to move through the bloodstream from another source of infection in the patient’s body. Pathogens can be different - tubercle bacilli, cocci, chlamydial pathogens, intestinal flora and others.

Initially, the inflammation process affects the mucous surface of the fallopian tube and if treatment is not started, the disease penetrates into the deeper layers of tissue. In advanced cases, adhesions of the fallopian tube will occur and obstruction will occur. It leads to serious complications, treatment and restoration of the patient’s fertility is extremely difficult.

Classification of salpingitis in women

Chronic salpingitis. In some cases, it may not give external manifestations. But more often, with this type of salpingitis, patients primarily note aching and pulling painful manifestations in the lower third of the abdomen. Decreased appetite, severe fatigue, difficulty urinating, low-grade fever bodies with chills. Often, adhesions begin in the fallopian tubes and an ectopic pregnancy may occur.

Acute salpingitis. When it occurs, fluid collects in the fallopian tube and the tissue becomes inflamed. Always expressed by characteristic pain in the abdomen and back (lower back), vaginal discharge. Body temperature is increased.

When urinating, the patient experiences cutting and stabbing pains, during sexual intercourse – discomfort and pain. Menstruation is also painful. When purulent discharge forms and accumulates in the fallopian tubes, acute purulent salpingitis is diagnosed.

Purulent salpingitis. This form of the disease is characterized by a sharp increase in temperature, severe abdominal pain, fever, severe weakness and malaise. Purulent discharge is observed from the vagina. Menstruation is scanty or, on the contrary, too abundant, urination is difficult, sexual intercourse causes severe pain. The patient should urgently seek medical help.

Bilateral salpingitis. Since both tubes are involved in the process, the risk of infertility is very high if proper treatment is delayed. In some cases, the fallopian tubes have to be removed. With this type of salpingitis, patients report constant pain, severe weakness, painful intimate contacts, they may also cause bleeding. Nausea and poor appetite, uncharacteristic vaginal discharge, problems with urination, elevated temperature and feverish condition.

Causes of manifestation

Almost always, salpingitis begins when pathological microflora from the body of the uterus penetrates the fallopian tube. The infection subsequently spreads to the ovary or nearby tissues (for example, ligaments).

As the inflammatory process develops, liquid discharge (exudate) accumulates in the tube, its presence provokes a cicatricial and adhesive process.

At acute process cavities with purulent contents or serous fluid may form in the pipes. Such cavities can form an abscess affecting the ovary, and the infection can spread to the abdominal cavity, involving other pelvic organs.

The main pathogens that cause salpingitis:

• causative agent of chlamydial infection;
• gram-negative diplococcus (the causative agent of gonorrhea);
• intestinal flora;
• causative agent of trichomoniasis;
• mycoplasma;
• ureaplasma;
• staphylococci and streptococci;
• various viruses (herpes, cytomegalovirus);
• fungi.

Symptoms and signs

Usually the disease begins to manifest itself after menstruation. Happening sharp deterioration condition of the woman, against the background of elevated temperature, a feverish state and abdominal pain are observed. Pain may radiate to the sacrum and perineum.

Enteral manifestations are also possible in the form of excess accumulation gases, nausea, vomiting. Everything gets complicated severe weakness, accelerated heartbeat, severe pain in the muscles.

The vaginal discharge is characterized by a serous-purulent discharge with an unpleasant odor. When urinating, the patient notes pain and frequent urges.

Diarrhea is possible.

Sexual intercourse is difficult due to severe pain.

If pathological process is in a subacute form, the pain is not pronounced, the temperature is low, subfebrile. The condition of the patients is satisfactory.

The chronic form of the process can occur against the background standard temperature bodies. But at the same time, pain in the abdomen persists.

The process may worsen under the influence severe stress, increased load, low temperatures(hypothermia).

If the process is purulent, then not only the body of the uterus, but also the cervical canal, ureters and urethra, and rectum may be involved.

If the cause of salpingitis is chlamydia, then the symptoms are more subdued. But at the same time, salpingitis is complicated by inflammation of the endometrium and urethra, and destructive lesions of the tubes are observed. The result is development ectopic pregnancy, irreversible infertility.

Course of the disease

The process of development of salpingitis can be unilateral, or it can affect both tubes (bilateral).

First of all, inflammation affects the epithelium of the fallopian tube ( upper layer mucous membrane of the inner surface of the fallopian tube). The next stage is inflammation muscle fibers tubes and serous layer.

During the inflammatory process, discharge, serous or purulent form. These abnormal accumulations of infected fluid provoke the formation of adhesions and scars, both inside and outside the tubes. The presence of these symptoms indicates that the disease is progressing to a chronic stage.

If treatment is not started on time, the pathological process leads to the patient completely blocking the lumen of the fallopian tubes, causing their obstruction. This causes infertility.

Features of manifestations during pregnancy

Pregnancy and salpingitis are often incompatible. If a woman is diagnosed with “salpingitis,” this means, at the very least, the need for serious and thoughtful treatment in order to make pregnancy possible in the future.

In most cases, if the diagnosis is made correctly and the correct treatment regimen is prescribed, the process can be stopped and eradicated. A woman can conceive and carry to term normally healthy child. The earlier the disease is detected and therapy is started, the greater the chances of successful recovery.

Salpingitis can be unilateral or bilateral. Complete infertility occurs only when both fallopian tubes are affected by inflammation. If, as a result of pathology, one pipe is impassable, the second will remain active. But it should be borne in mind that if the one-sided process is missed, then the infection can quickly spread its influence to the second pipe.

With the onset of pregnancy, it is better to wait until treatment and make sure that the tests are in order. This is necessary so that the infectious agent cannot infect the fetus and harm it.

Many experts are of the opinion that salpingitis and pregnancy are incompatible. But with timely and correct treatment, conception is quite likely.

In that case. If salpingitis has developed during pregnancy, it is necessary urgent treatment. Therapy should be prescribed in a more gentle form. With absence therapeutic measures it could all end in an infected abortion or the death of the child.

If the cause of salpingitis is chlamydia or gonococcal infection, there is a high risk of transmission of infection to the child during childbirth.

Diagnostics and examinations

Inspection from manual inspection with salpingitis it will be very painful. The specialist will note the presence of liquid contents on the left or right, depending on the location of the process. The tissues will be swollen, so the infiltrate will not have clearly defined boundaries. If the process has reached a chronic form, then the appendages will be inactive due to the fact that fibrous and sclerotic processes take place in them.

The blood test will show an increased ESR and an increase in the content of leukocytes.

The specialist will definitely take a smear test in order to carry out microbiological analysis and identify the causative agent of the infectious process. In order to identify certain types of pathogens, the polymerase chain reaction method and the enzyme immunoassay method are used.

To visualize the process and determine the extent of its spread, ultrasound is used, both externally and through the vagina. The image shows thickening of the fallopian tubes, adhesions and scar formations, effusion, accumulations of serous fluid and pus, and tumor-like thickenings in places of its accumulation.

Very severe cases For salpingitis, diagnostic laparoscopy can be used. In this case, a laparoscope is inserted into the patient under anesthesia through small incisions in the abdominal wall and the area of ​​the fallopian tubes is examined, while it is possible to immediately take a smear directly in the area of ​​the infectious focus.

Danger and aggravation

The most common complication of salpingitis is inflammation of the ovary. The ovary is the area closest to the inflamed tube and the infection penetrates into it quickly and without difficulty. The symptoms of oophoritis are no different from salpingitis, the menstrual cycle is disrupted, painful stomach, fever, vaginal discharge.

It is often combined with inflammation of the uterine epithelium -.

Another complication is the accumulation of purulent discharge in the fallopian tube - pyosalpinx. With absence timely treatment there is a danger of pipe rupture and infection of the abdominal cavity - peritonitis, sepsis. If the treatment has been carried out and completed, then in this case a complication is possible in the form of disruption of the patency of the fallopian tube due to the adhesive process. In the future, this complication can cause ectopic pregnancy and infertility.

The disease carries with it various consequences for reproductive system patients – difficulties with conception, ectopic pregnancy. Even after complete recovery, they may still long time be observed painful sensations in the pelvic area, since the adhesive process affects not only the tubes themselves, but also the surrounding organs. Consequently sexual function complicated. Complete restoration of fallopian tubes damaged by salpingitis is impossible.

If salpingitis is in a chronic form, then exacerbations are possible when exposed to certain factors. They are brought to them stressful situations, sudden heavy loads, the influence of cold and so on.

Treatment of salpingitis

In the acute form of salpingitis, as well as chronic in the acute stage and various complications disease is carried out only in hospital conditions hospital. Outpatient treatment of salpingitis is possible only in remission.

The use of medications and treatment methods largely depend on the extent of the process and the presence of complicating factors.

This disease is characterized by the fact that the pathogens that cause it are highly resistant to most antibacterial drugs wide range. Therefore, such antibiotics are used only at the beginning of the disease, if antibacterial treatment has not yet been applied.

In order to assign effective antibiotic, carry out an analysis of the sensitivity of microorganisms to a particular drug.

If the disease is chronic, mandatory Immunostimulating drugs are prescribed. Also, to achieve the desired effect, they use stimulation of their own immunity by introducing their own blood and placental preparations.

If the disease was not diagnosed in time, the process is started, adhesions and scars may be detected. In these cases, medications are prescribed that soften adhesions and scars, relieve swelling, and improve the movement of fluids in tissues.

Widely used in the treatment of salpingitis medicines in the form of candles. Suppositories are used rectally. This helps to hit quickly active substance to the source of infection. In addition, various painkillers and anti-inflammatory agents are often used in suppositories to improve general condition patients, pain relief.

After the patient is treated with antibiotics, various methods of physical therapy are successfully used. They are effective for removing painful sensations, softening and resorption of adhesive formations.

The main method is electrophoresis of various medicines. Experts recommend combining dimethyl sulfoxide and iodine.

If salpingitis is combined with fibroids or endometritis, magnetic therapy is recommended.

Hydrotherapy, especially radon baths, has a good effect.

Acupuncture helps relieve pain and activates the patient’s defenses.

Microwave irradiation with decimeter and centimeter waves helps localize the process, prevents its spread and accelerates recovery.

In extremely advanced cases, if all other methods have failed, and also if there is a threat to the patient’s life, surgical treatment has to be used. This can be an operation with preservation of the fallopian tubes (conservative), or their complete removal (radical).

Folk remedies

It is impossible to completely cure salpingitis using folk remedies. These methods can be used as a complement to the main therapy and only after consultation with a specialist.

• Grind 100 grams of anise seeds and mix with 0.5 kg of honey. Use this mixture for oral administration, a small spoon before meals, in the morning, afternoon and evening;

• herbal mixture - chamomile flowers, anise seeds and elderberry in equal proportions, mix and chop. Fill hot water and boil over low heat for 2 - 3 minutes. Take 0.5 cups orally in the morning, afternoon and evening before meals;

• Grind the juniper berries and branches and add hot water, bring to a boil and leave for two hours. Use the resulting product in an amount of 50 grams for a bath. Take a bath for half an hour.

Treatment practice

The patient needs strict medical supervision, so she will need to be in inpatient conditions. Bed rest is recommended and calm environment. You need to follow a gentle diet.

Based on the tests performed, correct antibiotic therapy is prescribed. The duration of therapy will be from 10 days to two weeks.

Antibiotic therapy is supplemented with the use of vitamin supplements and physiotherapeutic procedures. Acupuncture is used to relieve pain.

Prevention

First of all, to prevent the disease, it is necessary to detect and treat it in a timely manner. infectious diseases genital area. To do this, you need to regularly go to the doctor for examination and get tested. All identified infections must be cured completely, preventing them from becoming chronic.

It is important to provide treatment to your partner as well to avoid re-infection.

Need to stay away random connections, avoid unprotected contacts.

It is imperative to maintain high immune status to resist infections.

Pathogenic agents can enter the body when the mucous membranes are injured, so it is undesirable to use intrauterine devices.

Forecast

In the chronic form of salpingitis, the prognosis is unfavorable. It often causes infertility. Most of all, this concerns a bilateral process, since both fallopian tubes are affected.

For left-sided salpingitis, the prognosis is favorable if the woman consulted a specialist in a timely manner and the correct treatment was carried out. After a few weeks, normal functioning of the organs can be resumed.

With right-sided salpingitis, the prognosis is also favorable if it is diagnosed in a timely and correct manner. After a few weeks, the normal functioning of the reproductive organs is restored.

Acute salpingitis is characterized by piercing pain in the abdomen, mild chills and all the signs of poisoning. Both chronic and acute forms of the disease can lead to reproductive dysfunction and constant pain in the genitals.

This disease usually does not affect the fallopian tube, but immediately becomes bilateral, affecting muscle tissue the walls of both pipes.

What it is?

Salpingitis is an isolated infectious and inflammatory disease of the uterine (fallopian) tube of one or two-sided nature, often leading to its obstruction and, as a result, infertility.

As an isolated inflammatory process, salpingitis occurs infrequently; in most cases, inflammation from the area of ​​the fallopian tubes spreads to the ovaries (oophoritis), and acquires the features of a combined inflammation of the appendages (salpingoophoritis). Often inflammation of the uterine appendages (ovaries and tubes) is combined with endometritis (inflammation of the uterus).

Causes of the disease

Salpingitis can be caused by pathogens various types and classes of pathogenic and conditionally pathogenic microorganisms- bacteria, viruses, fungi and protozoa.

Depending on the causative factor The disease is conventionally divided into:

1. Specific salpingitis - often bilateral, is caused mainly by infectious agents sexually transmitted diseases. Specific salpingitis is the most common cause infertility. It is caused by chlamydia, trichomonas, mycoplasma, ureaplasma, gonococcus, cytomegalovirus, herpes simplex virus type II, papillomavirus infection, mycobacterium tuberculosis (very rarely).
2. Nonspecific salpingitis, which is caused mainly by epidermal or Staphylococcus aureus, streptococcus, coli or enterococcus, gram-positive anaerobic microorganisms that do not form spores (peptococci and peptostreptococci), yeast fungi and some others. As a rule, the damage is unilateral.

An increased risk of inflammation of the fallopian tubes is observed in the following cases:

1. Douching increases the risk of salpingitis, as it promotes the spread of bacteria from the vagina into the uterine cavity and fallopian tubes.
2. Gynecological procedures (endometrial biopsy, curettage, hysteroscopy, abortion, etc.)
3. If a woman has had many sexual partners with whom she has had sex without a condom.
4. If a woman has previously had one of the sexually transmitted diseases (gonorrhea, chlamydia, trichomoniasis, etc.)
5. Availability intrauterine device increases the risk of salpingitis in the first 4 months after installation of the IUD.

Especially often inflammatory processes are caused by multiple mixed microbial flora (polymicrobial association), for example, staphylococci with E. coli, gonococci with chlamydia, enterococci with staphylococci and streptococci, clostridia with peptostreptococci, E. coli with enterobacteria and Proteus, etc.

Each type of infection has its own routes of infection and features of the mechanism of development of the inflammatory process. For example, gonococcus is characterized by a purulent nature and bilateral damage.

Salpingitis and oophoritis

Often salpingitis occurs not alone, but together with oophoritis (inflammation of the ovaries). The causative agents of oophoritis include various microorganisms, often found in combination and at the same time quite resistant to antibiotics.

With such a combined disease, the process of soldering the fallopian tube altered due to the inflammatory process with the ovary occurs and a single extensive inflamed formation is formed, which has very serious consequences.

Acute salpingitis

The disease begins with an increase in temperature to high numbers, as well as with general malaise. Heartbeat increases.

Symptoms of acute salpingitis:

• vomit;
• nausea;
• Strong headache;
• pain in the groin area – important diagnostic symptom. Its localization depends on which of the tubes the inflammatory process has developed;
• pathological discharge. With gonococcal salpingitis appear purulent discharge, with trichomonas - foamy and abundant. If acute salpingitis proceeds very hard, then the appearance of bloody discharge. It is worth noting that the discharge in this disease is always abundant, and it is accompanied by burning and itching.

Acute salpingitis occurs and progresses due to infection entering the oviduct. The path of entry into the pipes is ascending or from a lesion that already exists in the woman’s body (appendicitis, oophoritis). In most clinical cases, acute salpingitis develops against the background of an ectopic pregnancy. The symptoms of this disease are very pronounced.

Chronic salpingitis

If treatment of acute salpingitis was not carried out or was not started in a timely manner, it begins to form in the fallopian tubes. chronic inflammation. Chronic salpingitis does not have a pronounced clinical picture; during periods of remission it is asymptomatic, and frequent exacerbations occur in a subacute form.

As a rule, the symptoms of chronic salpingitis are associated with complications that arise after acute inflammation. The most significant symptom of chronic salpingitis is pelvic pain. Their appearance is associated with adhesive process, and the intensity is directly dependent on the severity of the adhesive process. Adhesions change the location of organs and affect their mobility. A pronounced adhesive process causes prolonged nagging pain lower abdomen, worsening with physical activity, menstruation or sexual activity. If, as a result of acute inflammation, the genital organs are slightly damaged, pain appears only during an exacerbation.

Exacerbation of chronic salpingitis occurs without severe fever, the temperature does not exceed subfebrile norms, and general health remains normal. If the infectious-inflammatory process in acute period The disease has spread to the ovarian tissue and caused structural disturbances in it; chronic salpingitis may be accompanied by menstrual irregularities. Menstruation becomes heavier, longer and more frequent.

The most common reason for visiting a doctor by patients with chronic salpingitis is infertility. Long-term existing inflammation in the uterine tubes lead to their anatomical and functional deformation: the tubes thicken, their lumen narrows, and the inflammatory exudate glues the walls of the tube together, forming adhesions. Advancement of a fertilized egg into the uterine cavity under such conditions becomes impossible.

A dangerous situation is when the tube remains partially passable, then the egg stops inside the tube and, mistakenly believing that it has reached the uterus, is implanted into the wall of the tube and begins to develop. Under the influence of a growing pregnancy, the tube stretches and then ruptures. Ectopic pregnancy - dangerous complication chronic salpingitis.

Diagnosis of salpingitis

Diagnostics consists of detecting immobile, painful tumors of varying consistency. For correct diagnosis Salpingitis is of utmost importance to determine the probable infectious diseases of a woman. So, for example, salpingitis diagnosed in a young girl is most likely of tuberculosis origin, and salpingitis in a married woman nulliparous woman signals a gonorrheal infection. The presence of infection is determined laboratory research uterine discharge.

Pain syndrome during salpingitis is often confused with an attack of appendicitis due to the similarity of the nature of the pain. However, salpingitis gives pain located in more deep sections pelvis The disease is often diagnosed in combination with an ectopic pregnancy. Confirmed diagnosis Salpingitis is a disease unfavorable in terms of cure. Most often, the disease has the ability to remind itself throughout the entire period of functioning of the female reproductive system. IN medical practice cases of death of patients from peritonitis caused by running form acute salpingitis. Curing the disease in order to completely functionally restore the patency of the fallopian tubes to achieve the pregnancy desired by the patient occurs in very rare cases.

Consequences

Neglected or untreated disease causes serious complications:

• the infectious process spreads to the abdominal organs and pelvic area;
• scars and adhesions form, which can lead to fusion of the fallopian tubes;
• the risk of infertility increases;
• the possibility of an ectopic pregnancy increases significantly.

If a woman contacts a gynecologist in a timely manner and the disease is properly treated, the prognosis, as a rule, is favorable: salpingitis is cured, complications do not develop, and the likelihood of conception increases.

How to treat acute salpingitis?

First of all, they begin to treat acute salpingitis with a prescription bed rest and an easily digestible protein diet. Should be supported protective forces body with sufficient intake nutrients without irritating the intestines from fried or spicy food. If you have no appetite, you can abstain from food for several days, but be sure to eat a large number of warm liquid - tea, fruit drink, compote.

Antibiotics are prescribed based on assumptions about the causative agent of salpingitis and, as a rule, drugs are combined in such a way as to cover the widest range of microorganisms. For example, 3rd or 4th generation cephalosporins (ceftazidime, ceftriaxone) and metronidazole - this combination is active against aerobes and anaerobes. The course of treatment depends on the type of pathogen; when treating chlamydia, its duration reaches 21 days and can be repeated several times. Such measures lead to death intestinal microflora Therefore, at the end of antibiotic therapy, it is recommended to take preparations of lacto- or bifidobacteria.

To alleviate the woman’s condition, she is given intravenous solutions of glucose, sodium chloride, and polyglucins. Additionally, vitamins, immunomodulators, and desensitizing drugs (diazolin) are prescribed. Anti-inflammatory suppositories with indomethacin are used locally - they reduce the severity of the inflammatory reaction and damage to the tube tissue. Local sitz baths with solutions of chamomile, calendula, and potassium permanganate are shown.

Diet

Diet in the treatment of salpingitis is ineffective and insignificant. However, some recommendations are still given:

1. Drink plenty of fluids;
2. Eat crackers;
3. Use more vitamins through products;
4. Periodically consume low-fat dairy products and meat.

There is usually no strict diet here. It is advisable to exclude alcohol as one of the bad habits that suppress the immune system and irritate the gastrointestinal tract.

Is it possible to be treated folk remedies at home? Traditional methods no one cancels. However, they should not replace drug and surgical treatment, but supplement:

1. Baths with juniper, sage, valerian, rosemary or milk.
2. Douchings from herbal teas.
3. Therapeutic tampons soaked in a decoction of aloe, plantain or cabbage.
4. Herbal tea from various herbal mixtures.

Surgery

Treatment of salpingitis with surgical intervention applies as for acute forms this disease, as well as chronic ones. Indications for surgical treatment determined by the attending physician.

Indications for surgical treatment salpingitis are:

• ineffectiveness of conservative treatment;
• tumors in the area of ​​the uterine appendages;
• the formation of purulent formations in the area of ​​the uterine appendages;
• infertility of unknown origin;
• obstruction of one or both pipes as a result of adhesions.

The essence of the operation is to remove part of the fallopian tube, clean it of pus and disinfect it. If it is not possible to eliminate the purulent focus and restore the patency of the fallopian tube uterine appendage is deleted. At chronic salpingitis with a pronounced adhesive process, adhesions are also removed.

The most effective method The surgical treatment of salpingitis is laparoscopic surgery. It involves removing parts of the tube using special equipment through small holes in the abdominal wall. If using this method it is not possible to perform a full-fledged operation, then they switch to laparotomy. This operation involves cutting the anterior abdominal wall, which is done in order to gain full access to the pelvic organs. The method is more traumatic and provokes the formation of new adhesions.

The operation is performed in several stages. Initially, the doctor makes three punctures on the abdomen, through which medical instruments and laparoscopic equipment are inserted. Next, using a laparoscope, a special gas is pumped into the patient’s abdominal cavity ( carbon dioxide or nitrous oxide). This is done to ensure that the organs move away from each other, providing the doctor with good visibility. A laparoscope is a hollow tube with an eyepiece at one end and a video camera at the other. The doctor looks through the eyepiece internal organs, and with the help of a video camera the image is displayed on the monitor screen. The remaining incisions are intended for inserting manipulators, with which the doctor carries out the necessary actions.

During the operation, the adhesive formations are cut, and manipulations are carried out aimed at restoring the patency of the pipes. If inflammatory processes are detected during surgery, the doctor removes purulent formations, treats the cavity with disinfectant solutions and installs drainage system into the abdominal cavity.

Laparoscopic treatment allows a woman to go home within three days after surgery, however recovery processes will last up to two weeks. At the same time, doctors advise patients to temporarily refrain from sexual intercourse and visit the gynecological office at least once every 3 months.

Prevention

To prevent infection (remember, the ascending path is the most popular), it is recommended to maintain personal hygiene, use contraception against sexually transmitted infections, maintain immunity and visit a gynecologist at least once every six months.

Forecast

Timely treatment and adequate treatment guarantees complete cure and eliminating the consequences of the disease. The most favorable prognosis is when salpingitis does not cause obstruction of the fallopian tubes. In this case, treatment leads to full recovery and restoration of reproductive function.

The later a woman comes in, the worse the prognosis, accordingly. chronic form salpingitis is difficult to treat. And delaying treatment is fraught with the development of various reproductive dysfunctions. There is a high risk of ectopic pregnancy.