Update: October 2018
Inflammation of the uterus is the leading position among all
gynecological diseases. Inflammatory process that was
inadequately and untimely treated, threatens with a number of complications and
consequences, including the transition to the chronic form. Known
that about 20% of women undergoing adnexitis become
Inflammation of the uterus: what is it? The uterus appendages are
fallopian tubes, ovaries and ligaments. Inflammation of the appendages
called adnexitis or salpingo-oophoritis. Distinguish acute and
chronic adnexitis. Also, the inflammatory process can
develop on the one hand – unilateral salpingo-oophoritis,
and with both – bilateral adnexitis. In this article we will describe
causes, symptoms and treatment of inflammation of the uterus.
Causes of inflammation of the appendages
The causative agent of the inflammatory process in the uterine appendages are
pathogenic and conditionally pathogenic microorganisms that
certain factors become pathogenic. Distinguish
specific adnexitis caused by gonococci, bacillus
tuberculosis and diphtheria bacteria and non-specific
salpingoophoritis (chlamydia, mycoplasma, staphylococcus, streptococcus,
E. coli, fungi, viruses and other microorganisms). Often
the disease causes the association of microorganisms.
Infection in the uterine appendages can fall in different ways:
- ascending – from the vagina and cervix;
- descending – from other inflammatory organs (appendix,
- lymphogenous – on lymphatic vessels;
- hematogenous – through the blood vessels (typical for
tuberculosis of the uterus).
Factors contributing to the development of the disease:
- promiscuous sex life;
- non-compliance with the rules of intimate hygiene;
- stress, hypothermia;
- intrauterine procedures – abortions (consequences), curettage
uterine cavity, helix removal and insertion, metrosalpingography,
- complicated childbirth;
- weakening the body’s defenses – HIV infection, sugar
diabetes, recent infectious disease;
Symptoms of adnexitis
The clinic of an acute salpingoophoritis is very characteristic. Disease
begins acutely with a rise in temperature (up to 38 – 39 degrees),
with suppuration of appendages, chills appear. There are sharp, sharp
lower abdominal pain. Depending on whether one-sided or
two-way process, pain is localized in both or in one
ileal area. The pain is given in the rectum, in the sacral
area may radiate to the lower extremity.
At the beginning of the disease with palpation of the anterior abdominal wall
its tension (a symptom of muscular protection), sharp
soreness, symptoms of peritoneal irritation. May occur
signs of dysuria (painful and frequent).
The general condition of the patient suffers: a headache appears,
no appetite, nausea and vomiting.
When gynecological examination observed sero-purulent
or purulent discharge from the cervical canal. Appendage area at
probing painful, clearly define their size and contours
difficult, appendages pasty, enlarged, their mobility
is limited. In general, a blood test is determined by leukocytosis,
ESR acceleration. Also in the blood increases the content of C-reactive
Chronization process occurs when poor-quality treatment
acute inflammation of the uterus or in the absence of therapy
at all. Clinic of chronic salpingoophoritis erased, disease
proceeds with periodic exacerbations (usually in spring and
in the fall). Pain is characteristic, and its severity is not
corresponds to changes in the appendages. Symptoms of inflammation of the appendages
chronic nature – dull pain, aching, localized in the lower
the abdomen, radiating to the lower back and vagina. Palpation
the stomach is moderately painful.
Disrupted menstrual cycle, which manifests polymenorrhea
(heavy menstruation), oligomenorrhea (rare, short
menstruation, see the causes of scanty menstruation), algomenorrhea
(painful menstruation, see the causes of painful periods).
Menstrual dysfunction is associated with structural and
functional changes in the ovaries (hypoestrogenism, lack of
Sick women may also complain of a decline or
lack of sexual desire, pain during intercourse
(dyspareunia). With the continued existence of chronic adnexitis
suffer digestive (symptoms of enterocolitis, colitis),
urinary (symptoms of cystitis in women, pyelonephritis),
endocrine and nervous (neurosis, depression) systems.
The working capacity of such patients is decreasing, not infrequent in the family
With the exacerbation of the process, the temperature rises to subfebrile
figures (not higher than 38 degrees), the pain intensifies. During
gynecological examination observed mucopurulent discharge from
cervical canal, in the region of the appendages is determined by the hardness
(sclerotic changes), pain on palpation,
limiting their mobility and pain with displacement of the uterus by the neck
(due to the development of adhesions).
Сальпингоофорит опасен следующими complicationsми:
- transition to the chronic form;
- female infertility – due to the development of adhesions,
obstruction of the fallopian tubes, anovulation;
- the risk of ectopic pregnancy increases;
- развитие гнойного complications – тубоовариального образования
(purulent fusion of the tube and ovary with the formation
A practical example:
For the first time in my practice with tubo-ovarian education, I
faced in the second month of independent work. Received
young woman at night with signs of peritoneal irritation
(pelvioperitonitis), with severe intoxication syndrome and
severe lower abdominal pain. Preliminary diagnosis: Acute
adnexitis complicated by tubo-ovarian formation, acute
pelvioperitonitis. According to the rules, it is necessary to treat within 2 hours
(for removal of intoxication and pain intravenous infusion solutions with
antibiotics), and then urgently operate. After 2 hours called
duty surgeon (small hospital, doctors are few), which
was my classmate, and we went for an operation. When cut
stomach, I almost clutched my head. Spikes around, massive
purulent effusion in the abdomen, appendages on one side are not visualized
at all, but only a conglomerate of the alleged
appendages, omentum, colon and small intestine. We are with young
the surgeon began to determine what is what and how to cut it off. But, in
In the end, we performed the operation, albeit for 2.5 hours.
They removed what was needed, cut the commissures, washed the abdomen and drained it.
Впоследствии у женщины выявилась гонорея. Need to
to say that the operation was really difficult and not everyone
An experienced doctor will take on this. Later I operated a lot
tubo-ovarian abscesses, but more fortunately, such neglected
Cases not met.
- Treatment of inflammation of the appendages is carried out in the hospital and
starts with a diet that limits salt, pepper, and
carbohydrates and regime (in the first days of bed).
- With acute adnexitis and exacerbation of chronic patients
cold assigned to the lower abdomen (relieves inflammation and pain).
The main point in the treatment of inflammation are antibiotics.
Antibiotics are selected with a wide spectrum of action and maximum
half-life. Since the disease is often caused
microbial communities, 2 are used in antibiotic therapy and
- Klaforan 1.0 – 0.5 gr. 2 times a day / m and gentamicin 80 mg
3 times a day / m;
- cefobid 1.0 gr. 2 times a day / m in combination
- clindamycin 2.0 gr. twice a day in combination with
- Cefazolin 1.0 gr. 2 times a day in / m and ciprofloxacin 100.0 ml
2 times a day in / in;
- lincomycin 0.6 gr. 3 times a day / m;
Mandatory appointment of metronidazole 500 mg 3 times a day
orally or metrogyl 100.0 ml 2 times a day in / in (with
suspected anaerobic infection).
- In addition, detoxification therapy is carried out.
(intravenous infusions of saline solutions, glucose, hemodez,
reopoliglyukina and others in the amount of 2 – 3 liters).
- For relieving pain and reducing symptoms
nonsteroidal anti-inflammatory drugs are prescribed for inflammation
in tablets, see a list of tablets and injections for back pain Ibuprofen
(Ibuklin, Nurofen, Faspik), ketorolac (Ketanov, Ketarol),
Diclofenac (Diklak, Voltaren, Naklofen, Ortofen), etc., and
rectal suppositories (paracetamol, indomethacin, diclofenac, see
anti-inflammatory suppositories in gynecology with adsency).
- Also use vitamins (vitamin C, group B)
- Antihistamines (suprastin, pipolfen, cetrin and other
When removing the acute process and in the treatment of chronic inflammation
appendages without exacerbation are widely used physiotherapy:
electrophoresis of copper and zinc in the phases of the menstrual cycle,
electrophoresis with lidaza or iodine, ultrasound, pulse currents
high frequency (SMT, DDT). Also in restorative treatment
use immunomodulators, autohemotherapy, injections of aloe, FIBS,
Longidase and others. Chronic adnexitis is indicated.
Spa treatment – mud, paraffin, therapeutic baths and
douching (see how to do douching).