Adnexitis, a term formerly used to denote inflammation of the adnexal parts of the uterus (the ovaries and the fallopian tubes, hence it was often mentioned as salpingo-oophoritis in the literature) is now more commonly enclosed in pelvic inflammatory disease (PID), an infectious disorder of the upper genital tract that is principally seen in younger and sexually active women [1] [3] [4]. Many authors describe "adnexal masses" as distinct clinical entities, which may arise due to ovarian, tubal, or other abdominal etiologies in addition to PID [3]. Furthermore, the term "male adnexitis" was also used by some studies to illustrate this condition in males [2]. Regardless of the etiology, symptoms in the form of pelvic or abdominal pain, as well as tenderness and fever appear when the adnexa are affected by a pathological process [5] [6].

• Lower Abdominal Pain

  Clinical manifestations Adnexitis: acute or slowly progressive lower abdominal pain, often bilateral; frequently begins after menses; fever; palpable tender mass. [ultrasound-cases.blogspot.com]

  The symptoms of chronic unilateral and bilateral adnexitis: Lower abdominal pains are constant and may spread to the sacrum; pains are aggravated during defecation; Pain and discomfort during sexual intercourse; Menstrual disorders (changed amount of [brulanta.com]

  PID should be suspected in young, sexually active women who present with lower abdominal pain and adnexal/cervical motion tenderness! [amboss.com]

  The initial symptom (which may be in either the right or left upper quadrants)2 may often be overlooked with the moderately severe lower abdominal pain characteristic of acute pelvic inflammatory disease. [jamanetwork.com]

  Salpingitis may cause dull, cramping lower abdominal pain, fever, vaginal discharge, and fertility problems. Antibiotics and sometimes surgery are used to treat the condition. [myhealth.alberta.ca]

The diagnosis of adnexitis and adnexal pathologies relies on the ability of the physician to recognize the key signs and symptoms [5] [6]. For this reason, a detailed patient history and a thorough physical examination are crucial steps toward the diagnosis. Basic information, such as age, at-risk behavior, and ethnicity may significantly aid in narrowing the differential diagnosis if an adnexal mass is identified [4] [6]. As soon as clinical suspicion is raised, a full laboratory evaluation consisting of a complete blood count (CBC), serum inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and fibrinogen), a full coagulation panel, and serum electrolytes should be conducted [3] [6]. Ultrasonography (both abdominal, but more commonly transvaginal) is a useful first-line study that can detect numerous pathologies in the adnexa, but computed tomography (CT) and magnetic resonance imaging (MRI) are often recommended to solidify the diagnosis [3] [4] [5] [6].

1. Lauper U, Schlatter C. Adnexitis and pelvic inflammatory disease. [Article in German] Gynakol Geburtshilfliche Rundsch. 2005;45(1):14-18.
2. Diemer T, Gralla O. Male adnexitis. [Article in German] Urologe A. 2008;47(12):1573.
3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
4. Biggs WS, Marks ST. Diagnosis and Management of Adnexal Masses. Am Fam Physician. 2016;93(8):676-681.
5. Gradison M. Pelvic inflammatory disease. Am Fam Physician. 2012;85(8):791-796.
6. Bhavsar AK, Gelner EJ, Shorma T. Common Questions About the Evaluation of Acute Pelvic Pain. Am Fam Physician. 2016;93(1):41-48.