What Is Salpingitis?

Salpingitis is the main site of inflammatory diseases of the pelvic cavity. Most of them occur in women who are sexually active and have menstruation. They rarely occur before menarche, after menopause or unmarried. If it occurs, it is often the spread of inflammation in adjacent organs. Failure to get timely and correct treatment can result in sequelae such as infertility, tubal pregnancy, chronic pelvic pain, and repeated episodes of inflammation due to pelvic adhesions and tubal obstruction. Salpingitis is mostly caused by pathogen infection, mainly caused by staphylococcus, streptococcus, E. coli, gonococcus, proteus, pneumococcus, chlamydia, etc., which are divided into acute salpingitis and chronic salpingitis, the latter of which is in infertile women More common.

Basic Information

English name

salpingitis

Visiting department

Obstetrics and Gynecology

Multiple groups

Sexually active, menstrual women

Common locations

oviduct

Common causes

Pathogen infection

Common symptoms

Lower abdominal pain, fever, and increased vaginal discharge

Contagious

no

Causes of tubalitis

The disease is prone to occur when there are many bacteria, strong virulence, or decreased body resistance. Acute salpingitis is divided into two types according to the different types of pathogens: one is specific gonorrhea infection, and the gonorrhea spreads along the cervical mucosa and endometrium to the fallopian tube mucosa; the other is non-specific purulent bacterial infections Bacteria enter the connective tissue near the uterus through the lymphatic vessels and blood vessels from the endometrium, and finally cause peritubal inflammation and salpingitis. If further development of acute fallopian tube inflammation can lead to acute pelvic peritonitis and acute peritonitis.

Clinical manifestations of salpingitis

Salpingitis is the most common site of pelvic inflammatory disease, and it is often combined with inflammation in other parts. Its clinical manifestations can vary depending on the severity and extent of the inflammation. The mild ones are asymptomatic or mild. Common are lower abdominal pain, fever, and increased vaginal discharge. Abdominal pain is exacerbated by persistent, active, or sexual intercourse. If the condition is severe, there may be systemic symptoms such as chills, high fever, headache, and lack of appetite. If accompanied by peritonitis, there may be digestive symptoms. If an abscess is formed, there may be symptoms of lower abdominal mass and local compression and irritation; the mass may be irritated to the bladder in front of the uterus, such as dysuria, frequent urination, if it causes bladder myositis, and dysuria, etc. Symptoms of rectal irritation. If there are symptoms and signs of salpingitis and right upper quadrant pain, perihepatitis should be suspected.

The signs of the patients were very different. The mild patients had no obvious abnormality or gynecological examination found tenderness in the accessory area, and most of them were accompanied by inflammation in other parts. The physical examination also had positive signs in the corresponding parts. Severe cases are acute, with elevated body temperature, increased heart rate, tenderness in the lower abdomen, rebound pain and muscle tension, and even abdominal distension, bowel sounds weakened or disappeared. For gynecological examination, if there is simple salpingitis, the thickened fallopian tube can be touched, and tenderness is obvious; if it is fallopian tube empyema or fallopian tube ovarian abscess, the mass can be touched without tenderness and inactivity.

Salpingitis check

Blood test

The total number of white blood cells increased, and neutrophils accounted for more than 80%.

Blood culture

People with chills and high fever should have blood culture examinations to understand the condition, clarify the types of pathogenic bacteria and the sensitivity of the pathogens to drugs, so as to be targeted when applying antibiotics.

3. Smear or culture of urethral or cervical secretions

To understand pathogenic bacteria.

4. Back dome puncture

Exudate or pus can be punctured.

Salpingitis diagnosis

A preliminary diagnosis can be made based on medical history, symptoms, signs and laboratory tests. Due to the large differences in clinical manifestations, the accuracy of clinical diagnosis is not high. The ideal diagnostic criteria are both sensitive and specific. However, there is currently no single medical history, signs, or laboratory tests. Definitive diagnosis requires laparotomy or laparoscopic surgery to confirm the diagnosis. The secretions of the infected site are directly used for culture and drug sensitivity tests. The operability is poor. The secretions of the cervical canal or the dome puncture solution smears can also be taken. Culture and nucleic acid amplification to detect pathogens to assist diagnosis.

Salpingitis treatment

Acute salpingitis

Outpatient treatment: If the patient is generally in good condition, with mild symptoms, can tolerate oral antibiotics, and has follow-up conditions, oral or intramuscular antibiotics can be given in the clinic. Commonly used programs: ofloxacin 400mg orally twice a day, or levofloxacin 500mg orally once a day, while taking metronidazole 400mg 2 to 3 times a day for 14 days. Ceftriaxone sodium 250mg, single intramuscular injection, or cefoxitin sodium, single intramuscular injection, and probenecid at the same time, and then changed to doxycycline 100mg twice daily for 14 days, can At the same time, metronidazole 400mg was taken orally twice a day for 14 days; or other third-generation cephalosporins were combined with doxycycline and metronidazole.

Inpatient treatment: If the patient is in a poor general condition with severe fever, nausea, and vomiting; or has pelvic peritonitis; or tubal ovarian abscess; or outpatient treatment is ineffective; Comprehensive treatment based on antibiotics was given.

(1) General support and symptomatic treatment Absolute bedridden, semi-recumbent position to facilitate drainage and drainage, and help to limit inflammation. Drink plenty of water and eat a high-calorie, digestible semi-liquid diet. Those with high fever should rehydration to prevent dehydration and electrolyte disturbance. To correct constipation, take Chinese medicine, such as senna, or enema with saline or 1, 2, 3 doses. Those who are in pain can be given sedatives and analgesics. Acute peritoneal irritation symptoms can be applied to the painful area with ice pack or hot water bag. After 6 to 7 days, the actual condition has been determined by gynecological examination, total white blood cells, and erythrocyte sedimentation. Infrared or short-wave diathermy can be used instead.

(2) Antibiotic drug treatment to control infection The intravenous route of administration is quick and effective. The commonly used compatibility is as follows: The second or third generation cephalosporins or equivalent drugs can be used in combination with tetracyclines. Such as cefoxitin sodium, cefuroxime sodium, ceftriaxone sodium, etc., plus intravenous doxycycline. Clindamycin combined with aminoglycoside drugs. The combination plan of quinolones and metronidazole. Combined plan of penicillin and tetracycline.

After 24 to 48 hours of improvement in clinical symptoms, he switched to oral medication. For those who cannot tolerate doxycycline, azithromycin can be used instead. For patients with fallopian tubes and ovarian abscesses, clindamycin or metronidazole can be added to combat anaerobic bacteria more effectively. Treatment must be thorough, and the dose and application time of antibiotics must be appropriate. Insufficient doses can only lead to the generation of drug-resistant strains and the continued existence of lesions, which have evolved into chronic diseases. The sign of effective treatment is that the symptoms and signs gradually improve, which can usually be seen within 48 to 72 hours, so do not change antibiotics easily.

(3) Surgical treatment is mainly used when antibiotic control is not satisfactory. Surgical indications include ineffective medication, persistent abscess, and ruptured abscess. Surgery can choose laparoscopic surgery or laparoscopic surgery, mainly to remove the lesion.

After the abscess has formed, systemic antibiotics are not effective enough. If the fallopian tube and ovarian abscess are close to the posterior fornix, the vaginal examination of the posterior fornix is full and fluctuating, a posterior fornix puncture should be performed, and the pus can be cut through the posterior fornix to drain the rubber tube. If the pus is viscous and difficult to draw out, it can be diluted with physiological saline containing antibiotics to make it easy to be sucked out after gradually turning into bloody serum. Generally after 2 to 3 treatments, the abscess can disappear.

If the pelvic abscess punctures and breaks into the abdominal cavity, there are often changes in the general condition at the same time. Infusions and blood transfusions should be performed immediately to correct electrolyte disturbances and shocks, including intravenous drip antibiotics and dexamethasone. While correcting the general condition of the body, exploratory laparotomy should be performed as soon as possible to remove pus and remove abscesses as much as possible. After the operation, a silicone tube was placed on both sides of the lower abdomen for drainage. Postoperative gastrointestinal decompression and intravenous infusion of broad-spectrum antibiotics were used to continue to correct dehydration and electrolyte disturbances, and blood transfusions to improve body resistance.

2. Chronic salpingitis

Chronic salpingitis may be chronic, or it may be the consequence of untreated acute inflammation. Can be divided into chronic interstitial salpingitis, isthmus nodular salpingitis, fallopian tube empyema, fallopian tube hydrops, fallopian tube hemorrhage and so on. Often it is not cured, treatment is difficult, and its symptoms are mainly caused by pelvic adhesions caused by inflammation. Most of the pathogens of the infection have disappeared, and symptomatic treatments such as rest, enhanced nutrition, and supplementary physical therapy are often used.