Adnexitis (syn.: salpingo) - inflammation of the uterus (fallopian tubes and ovaries). Adnexitis caused by streptococcus, staphylococcus, chlamydia, gonococcus, Escherichia coli, Mycobacterium tuberculosis. Infectious agents penetrate into the uterus from the vagina, cervix and uterus, much less they spread through the blood and lymphatic vessels (eg, tuberculosis).
Infection most commonly occurs during the abortion, dilatation and curettage or other intrauterine manipulations. In the inflammatory process is usually initially involved the fallopian tubes (salpingitis), and then the ovaries (oophoritis). In some cases, the process extends to the surrounding peritoneum (periadneksit). Accumulation of inflammatory exudate in the lumen of the fallopian tube leads to the formation of saccular Education (saktosalpinksa). Accumulated in the lumen of the fallopian tube exudate can be transparent (hydrosalpinx) or purulent (piosalpinks). Adnexitis is unilateral and bilateral.
The clinical picture and course adnexitis depend on the agent and the reactivity of the organism. So, adnexitis caused by staphylococcus, streptococcus, gonococcus, occurs acutely or chronically, for chlamydial and tuberculous adnexitis typically chronic course.
Acute adnexitis characterized by severe pains in the abdomen and the sacrum. In some cases, pain may be accompanied by abdominal distention, nausea, vomiting, delayed stool. On palpation revealed a sharp pain in lower abdomen, sometimes with severe symptoms of muscle protection. Body temperature may rise to 39 ° C. In the blood revealed leukocytosis, shift to the left of leukocyte formula, the increase in ESR. The most serious complications in this period - the transition process in the pelvic peritoneum with the development and education pelvioperitonita abscess in the Douglas (recto-uterine) space. In the case of education piosalpinksa greater danger is rupture of the uterine tube, accompanied by infiltration of pus in the abdominal cavity and the development of purulent peritonitis. In uncomplicated cases of acute effects adnexitis keep 7 - 10 days, then the pain gradually subsides, the body temperature and blood counts normalized.
Chronic adnexitis developed independently or is the outcome of the acute process. Patients note pain in the abdomen and groin area, extending to the sacrum and rectum that are usually caused by formation of adhesions around the fallopian tubes and ovaries. Adhesions in the fallopian tubes can lead to a breach of their terrain, and infertility. In chronic adnexitis frequently observed violations of the menstrual cycle, manifested copious and prolonged bleeding. Often, especially in chronic adnexitis, the only sign of disease is infertility. Chronic adnexitis any etiology occurs with remissions and relapses, which are due to activation of dormant infections under the influence of exhaustion, hypothermia and other nonspecific factors.
The diagnosis was based on data from medical history, the nature of pain, their localization, increased body temperature, the results of a gynecological examination (two-handed study noted an increase in mobility and a violation of the uterus due to the formation of adhesions).
To find the cause of the inflammatory process is carried out bacteriological research separated the urethra, cervix and vagina to prevent gonorrhea conduct provocative test. In cases of suspected tuberculous etiology adnexitis used diagnostic curettage, seeding of menstrual blood, metrosal-pingografiyu, tuberculin test - Mantoux test, Koch. Gonococcus, Mycobacterium tuberculosis and Chlamydia usually causes bilateral, streptococcus, staphylococcus and E. coli - one-sided adnexitis.
With the introduction into clinical practice laparoscopy differential diagnosis with impaired tubal pregnancy (see ectopic pregnancy), parametritis, appendicitis, pelvioperitonitom much easier. When symptoms of acute abdomen (abdominal pain, nausea, vomiting, a symptom of muscular protection, etc.) shall organize an emergency paramedic and gentle transport of the patient on a stretcher to the nearest hospital.
Treatment of acute exacerbations of chronic and pronounced adnexitis spend in hospital. Patients were prescribed bed rest, mechanical and chemical light diet, the ice on the lower abdomen, antibiotics, sulfa drugs, painkillers. With the elimination of acute events may use physical therapy (ultrasound, ultrasound irradiation, electrophoresis of drugs, diathermy, paraffin baths). In chronic adnexitis, as well as at the end of the acute period (not earlier than 4 weeks) treatment is shown on mud spas and resorts with hydrogen sulphide and radon waters. When tuberculosis treatment adnexitis specific, conducted in a tuberculosis clinic or hospital.
The prognosis for uncomplicated adnexitis generally favorable, but in some cases may develop persistent infertility, menstrual dysfunction, increased risk of ectopic pregnancy.
Prevention focuses on preventing abortions, proper management of the postpartum period (infection prevention). For the prevention of exacerbations adnexitis should avoid exposure to cold, fatigue and increased physical activity, especially during menstruation. It must be remembered that casual sex is a source of infection and disease adnexitises.
The clinical picture and course adnexitis depend on the agent and the reactivity of the organism. So, adnexitis caused by staphylococcus, streptococcus, gonococcus, occurs acutely or chronically, for chlamydial and tuberculous adnexitis typically chronic course.
Acute adnexitis characterized by severe pains in the abdomen and the sacrum. In some cases, pain may be accompanied by abdominal distention, nausea, vomiting, delayed stool. On palpation revealed a sharp pain in lower abdomen, sometimes with severe symptoms of muscle protection. Body temperature may rise to 39 ° C. In the blood revealed leukocytosis, shift to the left of leukocyte formula, the increase in ESR. The most serious complications in this period - the transition process in the pelvic peritoneum with the development and education pelvioperitonita abscess in the Douglas (recto-uterine) space. In the case of education piosalpinksa greater danger is rupture of the uterine tube, accompanied by infiltration of pus in the abdominal cavity and the development of purulent peritonitis. In uncomplicated cases of acute effects adnexitis keep 7 - 10 days, then the pain gradually subsides, the body temperature and blood counts normalized.
Chronic adnexitis developed independently or is the outcome of the acute process. Patients note pain in the abdomen and groin area, extending to the sacrum and rectum that are usually caused by formation of adhesions around the fallopian tubes and ovaries. Adhesions in the fallopian tubes can lead to a breach of their terrain, and infertility. In chronic adnexitis frequently observed violations of the menstrual cycle, manifested copious and prolonged bleeding. Often, especially in chronic adnexitis, the only sign of disease is infertility. Chronic adnexitis any etiology occurs with remissions and relapses, which are due to activation of dormant infections under the influence of exhaustion, hypothermia and other nonspecific factors.
The diagnosis was based on data from medical history, the nature of pain, their localization, increased body temperature, the results of a gynecological examination (two-handed study noted an increase in mobility and a violation of the uterus due to the formation of adhesions).
To find the cause of the inflammatory process is carried out bacteriological research separated the urethra, cervix and vagina to prevent gonorrhea conduct provocative test. In cases of suspected tuberculous etiology adnexitis used diagnostic curettage, seeding of menstrual blood, metrosal-pingografiyu, tuberculin test - Mantoux test, Koch. Gonococcus, Mycobacterium tuberculosis and Chlamydia usually causes bilateral, streptococcus, staphylococcus and E. coli - one-sided adnexitis.
With the introduction into clinical practice laparoscopy differential diagnosis with impaired tubal pregnancy (see ectopic pregnancy), parametritis, appendicitis, pelvioperitonitom much easier. When symptoms of acute abdomen (abdominal pain, nausea, vomiting, a symptom of muscular protection, etc.) shall organize an emergency paramedic and gentle transport of the patient on a stretcher to the nearest hospital.
Treatment of acute exacerbations of chronic and pronounced adnexitis spend in hospital. Patients were prescribed bed rest, mechanical and chemical light diet, the ice on the lower abdomen, antibiotics, sulfa drugs, painkillers. With the elimination of acute events may use physical therapy (ultrasound, ultrasound irradiation, electrophoresis of drugs, diathermy, paraffin baths). In chronic adnexitis, as well as at the end of the acute period (not earlier than 4 weeks) treatment is shown on mud spas and resorts with hydrogen sulphide and radon waters. When tuberculosis treatment adnexitis specific, conducted in a tuberculosis clinic or hospital.
The prognosis for uncomplicated adnexitis generally favorable, but in some cases may develop persistent infertility, menstrual dysfunction, increased risk of ectopic pregnancy.
Prevention focuses on preventing abortions, proper management of the postpartum period (infection prevention). For the prevention of exacerbations adnexitis should avoid exposure to cold, fatigue and increased physical activity, especially during menstruation. It must be remembered that casual sex is a source of infection and disease adnexitises.
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