Hydrosalpinx: treatment and symptoms, diagnosisand reasons

Update: October 2018

One of the unpleasant effects of inflammation of the appendages, in
particular fallopian tube, is hydrosalpinx. According to
statistical data, this pathology occurs in 10 – 30%,
who are faced with the problem of pregnancy, since
hydrosalpinx interferes with the successful conception.

But at своевременном и адекватном лечении наступление
long-awaited pregnancy is quite possible, therefore it is not necessary
try to get rid of this disease yourself, it is only
aggravates the pathological process and delays the expectation of joyful
moment – the birth of a child.

Hydrosalpinx: what is it?

Hydrosalpinx is a disease of the fallopian tubes,
the consequence of which is a violation of their patency. Title
pathology comes from the Latin words, where “Hydro” translates as
liquid, and “salpinks” means a pipe. Phrase often
used by women – hydrosalpinx pipes – wrong, just
as well as oil. A feature of the disease is an accumulation in
the lumen of the fallopian tube fluid (transudate) due to blockage
internal and external openings of the oviduct, as a result of which
turns into a saccular formation.

There are:

  • right side hydrosalpinx;
  • hydrosalpinx on the left;
  • bilateral hydrosalpinx.

It is wrong to use such combinations as sharp and
chronic hydrosalpinx. This pathology is a complication
inflammatory process of the fallopian tubes – salpingitis, which can
to be both acute and chronic.

Example of a diagnosis wording: Acute bilateral
salpingoophoritis. Double sided hydrosalpinx.

Little anatomy and physiology

The fallopian tube (synonyms: fallopian tube or oviduct) is
paired organ and is presented as a hollow tube with two lumens.
The length of the oviducts reaches 10 to 12 cm, and the right tube is somewhat
longer than the left. One end of the oviduct opens into the uterine cavity,
and the other ends with fimbriae (villi) and opens in
abdominal cavity, near the ovary. With these holes
the abdominal cavity communicates with the internal and external genital
female organs, which increases the risk of ascending infection,
for example, with vaginitis.

The wall of the oviduct consists of three layers:

  • наружный – представлен  брюшиной и защищает трубу от
    negative influences;
  • мышечный – образованный  мышечными волокнами и благодаря
    which the tube commits peristaltic (contractile)
    movement towards the uterine cavity;
  • inner, covered with ciliated epithelium, the cilia of which
    wavy move (flicker), which facilitates movement
    оплодотворенной яйцеклетки в сторону uterus; besides glands
    located in the mucous layer of the pipe, produce a secret
    maintaining constancy of the internal environment of the oviduct and
    viability of the egg, sperm and zygotes.

The role of the fallopian tubes

Egg farmers are required for successful conception and implantation.
fertilized egg in the uterus. Tubal functions
include:

  • with the help of fimbria funnel pipes matured and released from
    egg follicle is captured (moment of ovulation);
  • the egg cell moves to the ampullary tube, where
    sperm are delivered from the uterine cavity;
  • maintaining the viability of germ cells (sperm and
    eggs), preparation for their connection, direct
    fertilization;
  • maintenance of the fertilized egg
    (зиготы) в трубе до перемещения ее в полость uterus;
  • transportation of zygotes into the uterine cavity due to peristalsis
    oviducts and increased cilia ciliated activity
    epithelium.

Pathology development mechanism

A malfunction of the fallopian tubes occurs due to
inflammation, for example, against the background of salpingitis or salpingoophoritis. AT
As a result, connective tissue begins to grow and
to form scars and adhesions. ATоспалительный процесс и
spike formation captures all layers of oviducts, with different
severity.

The villi of the ciliated epithelium die, and the muscular layer
stops shrinking (peristalsis disappears). AT просвете маточной
tubes grow adhesions, which violates its patency, and fimbria
funnel pipes stick together. When spikes close both holes
the oviduct, in the resulting enclosed space begins
build up mucus heavily due to inflammation produced
glands epithelium of the inner layer of the pipe. As a result труба
expands to form hydrosalpinx or sactosalpinx. With
suppuration of the serous-mucous contents of the tube is formed
pyosalpinx.

AT некоторых ситуациях (неполное спаивание фимбрий) образуется
�“Valve hydrosalpinx”, which periodically breaks in
the pressure of accumulated fluid. An increase in pressure occurs
with a sharp change in body position, straining, in the process
carrying out hysterosalpingography. With этом транссудат изливается в
pelvis. Oviduct emptying at valve hydrosalpinx
occurs systematically. Ofлившаяся воспалительная жидкость
stimulates the formation of adhesions in the pelvis – is formed vicious
a circle supporting the existence of hydrosalpinx.

Causes of hydrosalpinx

The formation of hydrosalpinx is due to the closure of the ampullar
the (medium) division of the fallopian environment, aided by the local
infectious and inflammatory reaction. Infectious agents may
penetrate into the cavity of the oviduct as ascending, from the underlying
reproductive organs (cervix, vagina, uterus) and
descending through the bloodstream (bladder and kidneys, tonsils and
intestine, appendix and others). Inflammation can be aseptic and
occur in the presence of other gynecological diseases.
The formation of hydrosalpinx occurs due to the following
reasons:

  • inflammation of the tubes, ovaries or appendages (salpingitis, oophoritis,
    adnexitis);
  • inflammation of the uterus (endometritis);
  • frequent and indiscriminate change of sexual partners (sexual
    infections: chlamydia, myco- and ureaplasmas, trichomonas, gonococci and
    others);
  • female genital tuberculosis;
  • wearing an intrauterine device;
  • frequent hypothermia (weaken the immune system and activate
    conditionally pathogenic flora);
  • abortion and diagnostic curettage of the uterus;
  • long-term vaginitis and vaginal dysbacteriosis;
  • inflammation of the cervix and cervix;
  • external endometriosis (causes aseptic inflammation and
    formation of adhesions in the pelvis);
  • adenomyosis;
  • myoma node in the area of ​​entry of the fallopian tube into the cavity
    uterus;
  • sexual infantilism (tubes are thin, long and convoluted);
  • damage to the oviduct during laparoscopy with
    the subsequent occurrence of aseptic inflammation.

Predispose the formation of saccular formation in the tube
following factors:

  • neglect of intimate hygiene rules;
  • stress, emotional stress;
  • endocrine pathology: diabetes mellitus, thyroid diseases
    glands (weaken the body’s defenses).

But I want to note that not always transferred and
treated salpingitis or adnexitis ends with formation
hydrosalpinx. With strong immunity and adequate and
timely treatment of the inflammatory process in the tube disappears without
consequences.

Symptoms

The clinical picture of the described pathology depends on
the disease that caused it. With hydrosalpinx that evolved on
background of acute inflammation of the tubes, the symptoms are more pronounced. The sick
worried febrile temperature, sharp, arching pain in the groin
(left or right), signs of intoxication: loss of appetite,
lethargy and weakness. With the rapid accumulation of transudate in ampullar
In the pipe section, the pain is arching and pulsating.

In the case of chronic salpingitis, accompanied by
the formation of hydrosalpinx, often patients nothing
worried. Often the only complaint is the impossibility
get pregnant and hydrosalpinx is found in the process
additional examination. But complaints of discomfort in
iliac areas, foreign body sensation in the groin,
pain during intercourse. If there is a valve
hydrosalpinx, then the woman may celebrate periodic abundant
watery discharge from the genital tract (in case of a breakthrough
into the uterine cavity). When transudate is released into the pelvic cavity in
it increases adhesions, which is manifested by the syndrome
chronic pelvic pain. Sometimes the symptoms of saccular
tube formation resembles acute surgical pathology
(appendicitis, renal colic or intestinal).

Typical signs of chronic salpingitis and
formed hydrosalpinx are:

  • discomfort or slight aching pain in the ileum
    areas / areas;
  • menstrual disorders;
  • pathological discharge from the genital tract;
  • absence of pregnancies.

Pregnancy against hydrosalpinx

Against the background of hydrosalpinx you can get pregnant, but in the case of
damage to the pipe on one side only. Accordingly, the probability
conception is reduced by 50%. However, with this disease increases
risk of tubal pregnancy and spontaneous abortion. Ectopic
pregnancy is caused by damage to the ciliated epithelium in
affected tube and violation of its peristalsis. As a result
fertilized egg is delayed in the oviduct for 4 or more
days, where it is implanted and continues to develop.

Spontaneous abortion on the background of the sacculate
Expansion of the pipe due to several points:

  • mechanical action: periodically pouring liquid from
    valve hydrosalpinx washes away the zygote from the surface
    endometrium, preventing it from being implanted;
  • inflammatory transudate hydrosalpinx, falling on the mucous membrane
    uterus, causes its damage and the development of endometritis, which makes
    implantation of the embryo impossible;
  • possible toxic effect of inflammatory fluid on
    embryo, which leads to its damage and death;
  • reduced sensitivity of endometrial receptors to female
    sex hormones, which leads to hormonal dysregulation
    the uterine lining of the implantation process.

If hydrosalpinx is diagnosed on both sides, then
pregnancy is not possible in a natural way. AT such
cases resort to assisted reproductive technologies
(IVF), although the efficacy of in vitro fertilization and
subsequent gestation of the fetus is reduced several times (2 –
five).

If the pregnancy still occurred on the background of the existing
saculae expansion tube, then it can interrupt
spontaneously in early and late periods. Therefore, all pregnant with
the presence of hydrosalpinx are classified as high risk
miscarriage. Disease treatment is set aside for
postpartum period.

Diagnostics

Diagnostics данного осложнения начинается с гинекологического
inspection. When conducting bimanual palpation hydrosalpinx can
feel like a tight elastic and oblong education
right / left or both sides. ATозможно появление незначительных
pains during palpation of the appendage area or their absence. But at
a small expansion of the oviduct the doctor may not palpate
education and assigns additional research methods:

Transvaginal ultrasound transducer

Determine the presence of a saccular formation with one or both
sides, located between the uterus and the ovary, its size and shape.
ATозможна визуализация перегородок в образовании (фолликулярный
hydrosalpinx). The formation is filled with hypoechoic fluid and
has its own thick capsule.

Hysterosalpingography

This method consists in the introduction into the uterine cavity through
cervical canal of contrast material (under pressure). After
what are the x-ray images. Hysterosalpingography
allows you to determine the permeability of the pipe – the contrast is visualized in
pelvis and reveal hydrosalpinx. In the presence of complications
the fallopian tube appears convoluted and thickened, in an expanded
the ampullary region shows accumulated contrast.

Laparoscopy

Conducted for diagnostic and therapeutic purposes. ATо время
laparoscopic surgery revealed thickened fallopian tubes,
fimbriae at their ends are swollen and hyperemic, and the pipe wall
thin and translucent, its cavity is filled with watery
content.

In addition to instrumental methods of examination must pass
tests for genital infections (chlamydia, myco-and ureaplasma,
цитомегаловирус, ATПЧ и вирус герпеса).

Treatment

When detecting hydrosalpinx woman strongly recommended
undergo treatment, because the longer this pathology exists, the
intensively formed adhesions in the pelvis, which reduces the chances of
conception and increases the risk of miscarriage or
the occurrence of ectopic pregnancy. Unfortunately, many
patients talk about this disease as not serious (not
it hurts, it means no danger) and delay the visit to the gynecologist. Sometimes it
irreversible consequences: absolute impossibility
conception naturally and the need to appeal to IVF.

But how to treat this pathology? Therapeutic measures for
hydrosalpinx are carried out in two stages. The first stage of treatment is
This is the conduct of conservative therapy. If there is a sharp
inflammatory process of the appendages or exacerbation of the chronic. AT
antibiotic treatment is given first. Duration
the course and dosage of antibacterial drugs are selected
individually, taking into account the identified pathogens and their
drug sensitivity.

The main line of conservative therapy is the stimulation
immunity. For this purpose, immunomodulatory drugs are prescribed.
facilities:

  • immunofan;
  • licopid;
  • imudon;
  • thymalin;
  • taktivin;
  • aloe injections;
  • immunal;
  • autohemotherapy (intramuscular injection of a woman’s own
    venous blood).

Also, to stimulate the immune system, parenteral administration is also shown.
the introduction of vitamins. Physiotherapeutic are widely used.
procedures, although to achieve full recovery hydrosalpinx and
resorption of adhesions with their help is impossible:

  • magnetophoresis;
  • UFO;
  • electrophoresis of electrolytes (calcium, magnesium);
  • electrostimulation of the fallopian tubes;
  • УATЧ;
  • endovaginal vibromassage.

Hirudotherapeutists are confident that you can get rid of this
disease, resorting to the method of treatment with leeches. Like
the statement has neither scientific evidence nor
verified statistics.

Folk methods

Most patients believe that treatment is possible.
hydrosalpinx folk remedies. ATрачи допускают использование
popular methods, but only as an addition to the first
(conservative) stage of therapy. Traditional medicine not
help get rid of the disease, but only eliminate a number of symptoms:
reduce pain, slow down the progression of inflammation and
adhesions, more or less normalize the menstrual cycle. Of
recommended folk remedies are permissible to use:

  • receiving pumpkin, potato and nettle juice (by
    separately or in a mixture);
  • microclysters with medicinal herbs (pharmacy chamomile,
    calendula, oak bark);
  • receiving a mixture of aloe leaves, butter and honey;
  • taking oatmeal infusion;
  • reception of juniper baths (an infusion of berries and
    juniper branches, the bath water should be warm, but not
    hot);
  • infusion of adonis;
  • infusion of a mixture of herbs (camomile, currant list, sage,
    St. John’s wort)

Once again I want to remind you that a complete cure of the disease with
using traditional medicine methods is impossible to achieve.

Surgery

ATторой ступенью лечебных мероприятий данного осложнения является
surgical intervention. In the presence of hydrosalpinx treatment
no operation makes no sense. While the focus of inflammation persists
the pelvis will continue adhesions, persist pain
and decrease the chances of fertilization.

To date, as a surgical intervention
applied laparoscopy with hydrosalpinx. Laparoscopic
treatment of saccular formation in the tube is the most gentle and
effective surgical intervention. AT процессе проведения
laparoscopy, depending on the condition of the tubes, the age of the patient and
her desires to get pregnant, the following types of surgical
Interventions in the anatomy of the oviduct:

  • salpingoovariolysis – adhesions around the oviduct and ovary
    dissected, restored their anatomical location, also
    adhesions in the lumen of the fallopian tube;
  • fimbriolysis and fimbrioplasty – end-section fimbriae
    tubes that are adjacent to the ovary are released from adhesions,
    inflammatory transudate is removed from the tube, if necessary
    plastic fimbriae is performed;
  • salpingostomy and salpingoneostomy – form a new
    the opening in the ampullary oviduct is either freed from adhesions
    anatomical hole (minus salpingoneostomy – new
    the hole grows very quickly);
  • tubectomy – removal of the tube / tubes (performed on women over 35
    years or when it is impossible to restore the patency of the oviduct and
    ликвидировать hydrosalpinx).

But even in the case of a successful operation, preserving the pipe
and restoring its patency the oviduct does not function as
before ATорсинки мерцательного эпителия либо утрачивают
mobility, or the epithelium itself atrophies, and the muscle layer is not
able to shrink in the old mode, that is, violated
peristalsis of the tube, so patients are put at risk by
ectopic pregnancy, and the occurrence of pregnancy recommends
through IVF.

ATопрос – ответ

What is the danger of this disease?

The presence of hydrosalpinx increases the probability
ectopic pregnancy. In addition, hydrosalpinx almost always
leads to infertility. Increasing saccular formation
into pipes may burst or fester (pyovar).

Do I need to comply with any restrictions under this
diseases?

Yes, sure. ATо-первых, следует избегать физической нагрузки
(vibration, straining, abrupt change in body position: somersaults,
tilts, jumps). ATо-вторых, избегать чрезмерной активности во
time of intercourse, which increases pain. Also not
It is recommended to sunbathe and visit the solarium, as well as visiting the baths,
Saunas and hot baths, which can provoke exacerbation
inflammatory process. It is undesirable to swim in the pool and
open reservoirs, as local hypothermia also provokes
aggravation. It is forbidden to drink alcohol, including
low alcohol drinks that suppress immunity.

What is the prognosis for pregnancy after laparoscopic surgery?
about this disease?

With the restored pipe maneuverability and removal
hydrosalpinx conception naturally and carrying a fetus
occurs in 60 – 75%, and the probability of occurrence of ectopic
pregnancy does not exceed 5%. AT случае удаления трубы эффективность
IVF is 30 – 35%.

What recommendations should be followed after surgical
treatment?

AT течение 3 – 4 недель необходимо воздерживаться от физических
loads and observe sexual rest. You should also follow
spicy, pickled and salty diets
food, fried and fatty dishes, fast food and canned food.

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