Tubal ovarian acute inflammation

Tubal ovarian acute inflammation


[Summary]



Salpingitis pelvic inflammatory genital the most popular kind. Tubal approaches ovarian, fallopian tubes can cause inflammation continue to expand ovarian inflammation. Salpingitis ovarian inflammation and the merger occurs, known as tubal ovarian inflammation or attachments inflammation. Although sometimes severe tubal inflammatory lesions, and the vicinity of ovarian still maintain normal. Individual ovarian inflammation rarely occurred. But mumps virus on ovarian have a special affinity and can be infected blood to a separate ovarian inflammation. Tubal ovarian inflammation occurred in the period of fertility age, 25 to 35-year-old the highest incidence of adolescent girls and menopausal women before and after rarely see.



[Diagnosis]




Tubal ovarian acute inflammation often causes a certain presence of, say, menstrual health and living conditions, the history is very important, because a lot of misdiagnosis often overlooked asked in detail about history.

Leukocyte count and erythrocyte sedimentation rate, to a certain extent help in the diagnosis. Interleukin 20 to the total number of 25 × 109 / L, neutrophils in the 0.8 to 0.85 and toxic particles, suggesting that there exists abscess. If the total number of leukocytes in the 10 ~ 15 × 109 / L, may no abscess, checks should be repeated several times, a check sometimes is not accurate enough. ESR over 20 ~ 30 mm / h, also often leads abscess formation. But to combine clinical manifestations and local inspection, the Comprehensive Analysis of judgement. Certain genital mucosa, such as tubal and cervical mucosa, and so may have a different produced by the pancreatic amylase, such reproductive amylase salivary amylase and difficult to distinguish. Now been found in the uterus, rectum Xianao ascites, such non-existence of the pancreatic amylase, including reproductive and salivary amylase known as the same kind of amylase, its normal 300 μ / L, respectively. When Ovductal by inflammatory damage, ascites in the same kind of content that is amylase decreased significantly reduce the degree proportional to the severity of inflammation, can be reduced to 40 μ / L, but with the same kind of serum amylase values still maintained at 140 μ / L. Therefore, the patients with suspected acute salpingitis, feasible vaginal fornix after the puncture to take some of the same kind of ascites amylase values at the same time admitted patients to determine blood enzyme values. Where the same kind of ascites amylase values / serum amylase same kind of business is less than 1.5, that the majority of the surgery were patients with acute salpingitis. The inspection has been acute Salpingitis think it is more reliable method for diagnosis.

In the gynaecological examinations at the same time, it would be preferable to send uterine cavity discharges from bacterial culture and sensitivity, the use of antibiotics as a reference.


[Treatment]




(A) General support and symptomatic treatment: absolute bed, semi-lying position to facilitate fluid drainage, and contribute to inflammation limitations. More influent and high calorie Yixiaohua semi-liquid diet. High fever should rehydration to prevent dehydration and electrolyte imbalance. Correct constipation, taking traditional Chinese medicines, such as senna, or 1,2,3-or saline enema. Pain can be disturbing to sedatives and analgesics. Acute peritoneal irritation with serious symptoms, can be deposited Ltd ice bag or pain location (cold or heat, whichever is the patient feel comfortable). 6 to 7 days after the gynaecological examinations and the total number of leukocytes, erythrocyte sedimentation rate tests have confirmed stable condition, or can switch to short-wave infrared Diathermy electrotherapy (see chronic tubal ovarian inflammation).

(2) Infection Control: intrauterine reference from the liquid smears or bacterial culture and sensitivity results, the choice of appropriate antibiotics. As such mixed infection of the more inflammatory, and in my most pathogens such as Escherichia coli and Bacillus are, in particular Bacteroides fragilis, and gonococcus or chlamydia infection than rare, it may choose to use gentamicin 80,000 U , 2 to 3 times intramuscular, or intravenous 240,000 U, such as metronidazole, 0.4 g served three times. Gentamicin good effect against E. coli, and metronidazole have effects on the anaerobic bacteria, and low toxicity, sterilization strong, cheap and thus has been widely used. Can be serious such as intravenous broad-spectrum cephalosporin antibiotics, amikacin, such as chloramphenicol. Treatment must be thorough, and the dose of antibiotics must appropriate time, can only lead to inadequate dose selection of resistant strains and the continued presence of lesions, into chronic illness. Effective treatment is a hallmark symptoms and signs gradually improved, generally within 48 to 72 hours can be seen, so do not easily change antibiotics.

In addition to severe infection antibiotics, the common use of adrenocortical hormones. Adrenal hormones can reduce the interstitial inflammation, and the lesions in the antibiotic concentration increased, filling the play its antibacterial effect, antipyretic and anti-venom, which will enable rapid cooling, fast absorption inflammatory lesions, in particular do not respond to antibiotics Strong cases better effect. Intravenous dexamethasone 5 ~ 10 mg of 5% glucose solution dissolved in 500 ml, 1, 1, slightly stable condition changed daily oral prednisone 30 ~ 60 mg, and reduced capacity to 10 mg daily, sustained one week. Suspended after the adrenal cortex hormones, antibiotics will continue to use four to five days.

(C) Local abscess puncture and injection of antibiotics: abscess formation, the effects of antibiotic use not ideal. Such as tubal ovarian abscess close to the posterior vaginal fornix, vaginal fornix full inspection and fluctuations flu, should be held after the fornix puncture confirmed the abscess, can be cut by the posterior vaginal fornix Bainong, placed Xiangpiguan drainage or aspiration to net contents, and then By the same needle injection of penicillin 800,000 plus gentamicin 160,000 U U (dissolved in saline). If not wound pus viscous extract can be diluted with saline antibiotics, blood serum that gradually turned into a kind of after easily aspirated. General after 2 to 3 times treatment, abscesses can disappear.

(4) If the pelvic abscess ruptured into the abdominal perforation, often at the same time there are systemic changes in circumstances, should immediately transfusion, blood transfusion, electrolyte imbalance corrected, and correct shock, including intravenous antibiotics and drugs such as dexamethasone. In normal circumstances at the same time to rectify as soon as possible exploratory laparotomy to eliminate wound pus, as much as possible with abscess. Of Albert, placed on both sides of the lower abdomen silicone tube drainage. Postoperative gastrointestinal decompression and intravenous broad-spectrum antibiotics, to continue to correct dehydration and electrolyte imbalance, blood transfusions, to increase body resistance.


[Etiology:




(1) menstrual period, post-abortion or postpartum women of reproductive tract infection resistance weakened physical defense. Normal vaginal acid because menstrual blood or Elu change; possession of mild cervical laceration or expansion, mucus suppository disappeared normal uterine endarterectomy, the uterine cavity surface exposed, expansion of sinusoids and coagulation block for the good breeding of bacteria ; postpartum uterine involution process of the resistance to infection is low. Therefore, do not pay attention to, say, menstrual health or sexual life, the bacteria vulnerable uplink mucosa caused endometrial tubal infection. This is the most common cause of morbidity and infection channels. Menstrual lower abdomen cold or operating long time in cold water, weakening resistance to the body and cause acute inflammation Annex, also in the clinical encounter.

(B) gonococcus infection in some countries led to acute inflammation of the fallopian tube ovarian the main reason, have occurred in China in recent years, so the gonococcus infected patients must pay attention to this situation.

(C) Disseminated Mycobacterium tuberculosis to the fallopian tubes, mainly due to the blood circulation. Other infectious diseases such as purulent tonsillitis, diphtheria, mumps, typhoid fever and paratyphoid fever, scarlet fever and other pathogens can be dual blood disseminated, cause acute inflammation annex.

(D) tubal adjacent organs inflammatory diseases, such as appendicitis, colonic diverticulitis can go far to spread through direct contact with fallopian tube.


[Pathological changes:




(1) reproductive tract mucosa ascending infection spread from the tube tubal endometrial uveitis, mucosal edema, or serous from purulent exudate. Start inflammatory lesions smaller limited to mucous layer, quickly spread tubal inflammation floors, tubal serosal layer final involvement, and there is serous lost luster cellulose calmly - tubal periimplantitis. Then tubal swelling, congestion, redness, curly. Congestive mucosal vascular extreme, there may be the large number of erythrocytes containing the bloody exudate, known as hemorrhagic salpingitis. Further increase inflammation, in the fallopian tube lumen contains a lot of purulent secretions. Since fallopian tube and peritoneal I invagination umbrella of the Department of adhesion and atresia. This disease can prevent wound pus into the abdominal cavity to prevent further spread of inflammation, and so prevent caused pelvic peritonitis. Because tubal uterine mucosa high-swelling, and intrauterine channel was also blocked.

Endoscopic findings: Ovductal thickening, congestive, interstitial edema, a large number of infiltrating neutrophils, epithelial sheet loss caused adhesions. Exfoliated epithelial necrosis lumen containing a large number of inflammatory cells and formation of purulent secretions. Myometrial serosal layer and also from the severity of the inflammatory response. Lymphangioma and telangiectasia, a polymorphonuclear leukocyte and thrombosis, and the muscle had a small abscess formation (photo 1).



Photos 1 acute Salpingitis

(B) tubal empyema. Locking-on both sides of the fallopian tube, resulting in a tubal pregnancy cavity wound pus, and with the development of inflammatory lesions growing, and a tubal empyema. Tubal ampulla muscle thin, easy expansion, thick muscle isthmus very difficult to swell, thus the shape of tubal empyema-neck bottles, gradually swelling to the ampulla, the largest diameter of up to 12 ~ 15 cm, while tubal Variable extend their own, and falling behind in the broad ligament. For the contents of serous purulent or mucus purulent. Tubal empyema often associated with the surrounding tissue and organ adhesions, such as broad ligament posterior lobe, ovary, sigmoid colon, ileum, and sometimes falling to the uterus rectum Waterloo, and the Department of peritoneal adhesions. Then tubal thickening, a dense tenacious cystic mass.

If the bacteria highly toxic, inflammatory lesions continue to develop, empyema increased thinning can swell the fallopian tube perforation and rupture, and cause pelvic peritonitis or diffuse peritonitis. Sometimes also to the rectum, vagina posterior fornix perforation, even to the bladder perforation.

(C) from the palace wall or cervical lymphatic spread outward, in the first general Gongpeng organizations have varying degrees of lymphatic and lymph node inflammation around the vein and vein inflammation around the broad ligament and cellulitis. Inflammation continued to deepen and expand to tubal of the peritoneal membrane and fallopian tube, the final tubal wall involvement. Therefore, this type of tubal interstitial inflammation, mucosal involvement is very light, not even started. Its cross-section of the fallopian tube can be seen Notable Films tubal wall thickening and obvious infiltration, and the lumen may be normal, and the epithelial lining can be no inflammatory response. Therefore, the mucosa and direct uplink spread of the inflammatory lesions, and the impact on the reproductive smaller, even though there are very serious pelvic inflammatory disease of the future may still pregnancy. Gongbang such cases before Salpingitis connective tissue inflammation, which have varying degrees of uterine fixed.

Were observed: mucosa normal or mildly inflammatory infiltration, edema and muscle due to the extreme thickening of leukocyte infiltration, serosal layer often have a certain degree of fiber acute peritonitis.

(D) In the acute phase of salpingitis, through serous ovarian inflammation of the fallopian tube directly or through the spread of ovarian membrane and membrane of lymphatic spread of the infection. The former is limited to the inflammatory response of ovarian surface exudation and cellulose into shape so that normal ovarian wrapping around in the adhesion of inflammatory tissue. Inflammation serious, invasive ovarian essence, multiple abscesses can occur, particularly vulnerable freshmen invasive mature follicles or luteal within the follicle formation - luteal abscess, abscess integration from multiple ovarian abscesses. Fallopian tube and ovarian abscesses often through empyema, a tubal ovarian abscesses, pelvic abscess is the most popular kind.

(5) acute inflammation tubal ovarian Most bilateral involvement, the disease may be lighter side. Yan occasionally unilateral tubal ovarian appendicitis or diverticulitis inflammation in the direct spread to annex the inflammatory lesions. Very individual puerperal infection can occur side of the annex infection, or even a great side and the other side of tubal empyema no.

In the acute phase of pelvic peritoneum Salpingitis often mild infection, and serous fluid leakage. Serious change can occur suppurative formed wound pus. Wound pus can be accumulated in the uterine rectum fossa (Figure 1), after vaginal fornix can palpable tension to the pain of the masses. Waterloo uterine rectal abscess or directly from infected fallopian tube, when the umbrella-no atresia, in the fallopian tube cavity from the abdominal wound pus extraoral, from the depths of accumulated in the pelvis.



Figure 1 Waterloo uterine rectal abscess


[Clinical]




General infection within two weeks after onset, prior malaise, loss of appetite, and other systemic symptoms, a high fever incidence is 39 to 40 ℃, pulse rate of 110 to 120 beats / min, there may be shivering or Wuhan, on both sides of the lower abdomen drama pain, stool aggravating. Sometimes urinate and pain, abdominal distension and constipation. Stool mucus in the colon wall with inflammatory infiltration by stimulating phenomenon. Often menorrhagia, the menstrual period is extended or menstrual disorders and purulent Leucorrhea.

Signs: acute capacity, facial flushing, dry tongue-thick moss, especially abdominal tenderness obviously lower abdomen, and rejected by, muscular stiffness, and anti-Tiaotong obviously, and the dark intestinal.

Gynaecological examinations: a purulent vaginal secretions or blood, cervix there are varying degrees of redness. Gonococcus case of infection in the vestibule outside the gland Xianguan mouth, urethra, mouth and cervix can be seen at the site of a wound pus or extrusion. Double up when a mobile cervical pain. Because patients Patong and abdominal tension is often difficult to identify pelvic the situation. If palpable-uterus, are generally more fixed uterus, normal or slightly increased, intense tenderness. Annex generally tenderness on both sides, the general mass Annex difficult to ascertain.

Fallopian tube in patients with acute ovarian sometimes can be associated with liver inflammation around (Fitz-Hugh-Curtis) syndrome, for the performance of the right lower chest or right upper quadrant pain, cholecystitis, or pretty close to right pleurisy symptoms. Gonococcus or Chlamydia trachomatis infection may have caused such a situation, the latter more likely. This disease is often misdiagnosed as acute cholecystitis.

When the tubal ovarian abscess formation, although the active treatment, the temperature is still high, a missed flip-heat or heat, clock speed fine, peritoneal irritation symptoms become more evident, and often oppressed and rectal pain. Gynaecological examinations uterine tenderness and Annex has been evident in the pelvic side or both sides of the tension can be touched and slightly capsule sense of pain mass. Such as uterine rectal abscess in Waterloo, vaginal fornix flu checks can be filled prominent, DRE, feeling more obvious.

Fallopian tube to ovarian abscess ruptured abdominal perforation, suddenly felt severe pain patients, and continue to increase, there are nausea, vomiting, chills, then the patient was pale. Decreased blood pressure, pulse-rate, a cold sweat, and other clinical shock. Check with diffuse abdominal tenderness, and abdominal obvious anti-Tiaotong ankylosis. Abdominal breathing disappeared, and abdominal distension, intestinal paralysis, and other symptoms, need emergency treatment. If vaginal or rectal abscess to the posterior vaginal fornix perforation, or can be anal or vaginal discharge large quantities wound pus, and then illness that is a marked improvement.


[Diagnosis]




Tubal ovarian acute inflammation clinical manifestations of acute abdomen, and acute appendicitis, ruptured tubal pregnancy, ovarian cystic tumor torsion and acute inflammation of the pelvis identify, as shown in table 21-1.

Table 21-1 in the differential diagnosis of acute Salpingitis

Salpingitis acute ruptured tubal pregnancy, abortion cystic ovarian torsion of acute appendicitis
History of progressive disease, multiple in menstruation, childbirth, abortion, no sudden onset of menopause may be repeated attack, there are short-term menopausal history, such as menopause about 40 days. Have nausea, vomiting, early reaction is a sudden onset, non-stop through history, there are abdominal mass in the history of acute onset, non-menopausal History
Vaginal bleeding may have menstrual disorders, by volume, menstrual lasted for a long time with more than a small amount of vaginal bleeding Some general absence of vaginal bleeding without vaginal bleeding
Main symptoms began fever, lower abdominal pain burning on both sides of the increasingly heavy. Nausea, vomiting fewer side of the lower abdomen, sudden severe pain sinkers, and then there are shock, the whole abdominal pain, not the side of the lower abdomen Zhuaice suddenly cramps, nausea, vomiting, the original mass can be consciously started the whole abdominal pain Swell Qizhou or pain, a few hours or even longer, fixed right lower abdomen. More with nausea, vomiting, anorexia, dry tongue, bad breath, yellow thick moss
Main signs of fever 39 to 40 ℃, facial flushing, mental stress, shame and around both sides of the lower abdomen area on the tenderness with the exception of a few cases the general fever, facial pale and weak, the whole abdominal tenderness, and anti-Tiaotong, voiced mobility, a lower abdomen Lateral tenderness generally not keen fever, pain outlook. Medium large abdominal mass can be touched. Cystic general, the general yarn obvious tenderness over 38 ℃, and acute capacity, Markov point tenderness, and anti-Tiaotong, muscular tension than
Gynaecological examinations Leucorrhea purulent or bloody, cervical tenderness, pain after fornix inconsistent, double tubal obvious tenderness, or thickening, or a little Anzi mass vaginal blood, cervical tenderness, the posterior vaginal fornix high, the uterus planktonic flu. Or the normal side of the annex, touched the side of the real tenderness flexible block vaginal clean side of the annex areas hit cystic mass, surface smoothness, activities, intense tenderness, uterine horn tenderness ipsilateral, contralateral (-) gynecological inspection, genital mutilation no abnormal findings.
DRE top right of resistance tenderness intestinal area

Laboratory and
Special inspection of leukocytes and neutrophils increased pregnancy test (-), posterior fornix for exudative fluid or puncture wound pus individual leukocyte count increased normal. Hemoglobin, the red blood cells decrease. Pregnancy tests can be positive, not for the posterior vaginal fornix puncture the dark red blood coagulation. B-scan can help diagnosis of high leukocyte count may be normal. B-scan help diagnosis of leukocytes and neutrophils were higher

(1) and acute appendicitis identification: the more serious lesions of the right fallopian tube and ovarian inflammation easily confused with acute appendicitis, acute appendicitis pain began in umbilical around, a few hours after the time limit or slightly Markov point, and acute tubal confined to the start of ovarian inflammation on both sides of the lower abdomen. Acute appendicitis accompanied nausea, vomiting, inflammation of ovarian and tubal dispensable. Acute appendicitis only mild fever, and increased leukocyte more obvious. Check points in the Markov appendicitis tenderness, salpingitis tenderness in the lower and bilateral. Appendiceal perforation with peritonitis, the identification more difficult, then abdominal pain, tenderness, muscular tension are involved throughout the lower abdomen, Jishi tubal ovarian inflammation. Although pelvic examination can be a sense of tenderness and resistance, but the intensity of it than tubal ovarian acute inflammation, which sometimes can be enlarged or touched annex annex abscess. But sometimes appendicitis affected ipsilateral annex or appendix uterine perforation after a pelvic abscess is difficult to identify the need laparotomy.

(B) Identification of inflammation and acute pyelonephritis: Although located in the pelvis on the kidneys, pelvis, but serious acute inflammation, and sometimes symptoms Jishi annex acute inflammation. Yan mainly in the pelvis, abdominal pain, but can be affected because the kidney area rib significant vertebral angle Kouji pain and tenderness at the same time have high fever, but patients suffering in the annex as a serious inflammation and appendicitis. Urine (catheterization or urine samples) check Nongxibao, RBC exist.

(C) with ruptured tubal pregnancy and abortion or cystic ovarian torsion of the differential in addition to table 21-1, can see the relevant sections. Difficult to identify, to their inflammatory treatment, close observation. The condition of patients can laparotomy.


[Prognosis]




Tubal ovarian acute inflammation timely diagnosis, proper treatment, the prognosis is good. Simple Salpingitis light after treatment often can be 2 to 3 days the temperature dropped, about one week tubal edema disappeared, a thickening of the fallopian tube in February to be fully absorbed. Tubal plica and ciliated epithelial return to normal, and will not affect fertility. Other types of salpingitis difficult to fully absorb most of the remaining varying degrees of salpingitis and peritoneal adhesions. Fallopian tube wall narrow tortuous lumen obstruction, umbrella-adhesion atresia and functional damage, resulting in infertility. But mesenchymal type of salpingitis mucosal lesions less serious lesions although tubal wall, falling cavity may tubal patency. However plica cilia destruction, the lumen of the narrow, once the pregnancy, as peristalsis of poor, slow transmission fertilized egg into the reasons for the ectopic pregnancy. Some may be due to various reasons for the evolution of chronic diseases (see chronic tubal ovarian inflammation).