ADNEXIT (syn .: salpingo-oophoritis) - inflammation of the uterus (fallopian tubes and ovaries).
Adnexitis is caused by streptococcus, staphylococcus, chlamydia, gonococcus, E. coli, Mycobacterium tuberculosis. The pathogens invade uterine appendages from the vagina, cervix and uterus body; much less often, they spread through the blood and lymphatic vessels (for example, with tuberculosis). Infection most often occurs during induced abortion, diagnostic curettage and other intrauterine manipulations. In the inflammatory process is usually first involved in the fallopian tubes (salpingitis), then the ovaries (oophoritis). In some cases, the process extends to the surrounding peritoneum (periadnexitis). The accumulation of inflammatory exudate in the lumen of the fallopian tube leads to the formation of saccular formation (saktosalpinksa). The exudate accumulated in the lumen of the fallopian tube may be transparent (hydrosalpinx) or purulent (pyosalpinx). Adnexitis is unilateral and bilateral.
The clinical picture and course of adnexitis depend on the pathogen and reactivity of the organism. So, adnexitis caused by staphylococcus, streptococcus, gonococcus, is acute or chronic, for chlamydial and tuberculous adnexitis a typical chronic course.
Acute adnexitis is characterized by severe pains in the lower abdomen and in the sacrum area. In some cases, the pain may be accompanied by bloating, nausea, vomiting, delayed stool. Palpation revealed a sharp pain in the lower abdomen, sometimes with a pronounced symptom of muscle protection. Body temperature can rise to 39 ° C. Blood leukocytosis , leukocyte shift to the left, an increase in ESR are detected. The most serious complications in this period are the transition of the process to the pelvic peritoneum with the development of pelvioperitonitis and the formation of an abscess in the Douglas (uterine rectus) space. If pyosalpinx is formed, a rupture of the fallopian tube is a great danger, accompanied by the penetration of pus into the abdominal cavity and the development of purulent peritonitis. In uncomplicated cases, the phenomenon of acute adnexitis lasts 7 to 10 days, then the pain gradually subsides, body temperature and blood counts return to normal.
Chronic adnexitis develops independently or is the outcome of an acute process. Patients note pain in the lower abdomen and in the groin, giving to the sacrum and anus, which, as a rule, is caused by the formation of adhesions around the fallopian tubes and ovaries. Adhesions in the fallopian tubes can lead to disruption of their patency and infertility. In chronic adnexitis, menstrual irregularities are often observed, manifested by abundant and prolonged bleeding. Often, especially in chronic adnexitis, infertility is the only sign of the disease. Chronic adnexitis of any etiology occurs with remissions and relapses, which are caused by the activation of the dormant infection under the influence of overwork, hypothermia, and other nonspecific factors.
The diagnosis is made on the basis of anamnesis, the nature of pain, their localization, increase in body temperature, gynecological examination results (in a two-handed study, there is an increase and impairment of the mobility of the uterus in connection with the formation of adhesions).
To identify the causes of the inflammatory process, bacteriological examination of the urethra, cervix and vagina is performed; to exclude gonorrhea, conduct provocative tests. If tuberculous etiology is suspected of adnexitis, diagnostic curettage, seeding of menstrual blood, metrosal-pingography, and tuberculin tests are used — Mantoux and Koch reactions. Gonococcus, mycobacterium tuberculosis and chlamydia usually cause bilateral, streptococcus, staphylococcus and E. coli - unilateral adnexitis.
With the introduction of laparoscopy into clinical practice, the differential diagnosis with impaired tubal pregnancy (see Ectopic pregnancy), parametritis, appendicitis, pelvioperitonitis has become much easier. When symptoms of an acute abdomen appear (abdominal pain, nausea , vomiting , a symptom of muscle protection, etc.), the paramedic is obliged to arrange an urgent and gentle transportation of the patient on a stretcher to the nearest hospital.
Treatment of acute and severe exacerbations of chronic adnexitis is carried out in a hospital. Patients are prescribed bed rest, a mechanically and chemically-sparing diet, ice on the lower abdomen, antibiotics, sulfa drugs, pain killers. During the liquidation of acute phenomena, it is possible to use physiotherapeutic procedures (ultrasound, ultrasound irradiation, electrophoresis of drugs, diathermy, paraffin applications). In chronic adnexitis, as well as at the end of the acute period (no earlier than after 4 weeks), treatment is indicated in mud resorts and in resorts with hydrogen sulfide and radon waters. In case of tuberculous adnexitis, the specific treatment is carried out in an antitubercular clinic or hospital.
The prognosis for uncomplicated adnexitis is usually favorable, but in some cases it is possible to develop persistent infertility, menstrual dysfunction, and the risk of ectopic pregnancy increases.
Prevention is aimed at preventing artificial abortions, correct management of the postpartum period (prevention of infections). For the prevention of adnexitis exacerbations, hypothermia, overwork and increased physical activity should be avoided, especially during menstruation. It must be remembered that promiscuous sex is a source of infection and adnexitis.