Adnexitis was initially a separated entity describing an ongoing inflammatory process in the ovaries and fallopian tubes. Today it is primarily described as a component of pelvic inflammatory disease (PID) (in the form of an adnexal mass), a term used to describe an infection of the upper genital tract by various pathogens. Non-infectious disorders, such as cysts, tumors, etc. can also present as an adnexal mass and produce inflammation. Pelvic pain, tenderness, and fever are some of the main symptoms. The diagnosis is made through clinical, laboratory, imaging, and microbiological studies.
Presentation
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].
Gastrointestinal
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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]
Workup
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].
Treatment
It seems that supplementary laparoscopic procedures might be more efficient than medical treatment alone. [ncbi.nlm.nih.gov]
The duration of this treatment - 10 days. [pharmacy-peoples.com]
Of course, the doctor should make the final diagnosis before prescribing treatment. [geeks-world.github.io]
National treatment of an adnexitis National treatment of an adnexitis is used quite widely, especially it is justified at a chronic adnexitis. [en.medicalmed.de]
"[Treatment of Chronic Adnexitis and Parametritis of Gonorrheal and Septic Etiology]." Medicinski Arhiv, vol. 8, no. 2, 1954, pp. 55-70. STAMBOLOVIC B. [Treatment of chronic adnexitis and parametritis of gonorrheal and septic etiology]. [unboundmedicine.com]
Prognosis
The prognosis for uncomplicated adnexitis generally favorable, but in some cases may develop persistent infertility, menstrual dysfunction, increased risk of ectopic pregnancy. [med-reference.blogspot.com]
Especially serious and unfavorable prognosis, if bilateral defeat of uterine appendages is observed. Not the best variant of a course of a chronic adnexitis - an ectopic pregnancy. [en.medicine-worlds.com]
[…] become prominent due to infection draining in to lymphatics along the course of the gonadal veins MRI May show an ill-defined adnexal mass containing fluid with various signal intensities: T1 C (Gd): wall and surrounding tissues may enhance Treatment and prognosis [radiopaedia.org]
[…] premature ovarian failure早発閉経（早発卵巣機能不全） premature rupture of themembranes前期破水 premature separation ofnormally implanted placenta常位胎盤早期剥離 premenstrual syndrome月経前症候群（月経前緊張症） presentation胎位 preterm早期 primordial follicle原始卵胞 primordial germ cell原始生殖細胞 prognosis [tokyo-med.ac.jp]
Public health efforts implemented in Scandinavia to decrease the prevalence of STIs have been quite effective in reducing the incidence of PID. [47, 48] Prognosis PID has 3 principal complications, as follows: Chronic pelvic pain Infertility Ectopic pregnancy [emedicine.com]
Etiology
Many authors describe "adnexal masses" as distinct clinical entities, which may arise due to ovarian, tubal, or other abdominal etiologies in addition to PID. [symptoma.com]
"[Treatment of Chronic Adnexitis and Parametritis of Gonorrheal and Septic Etiology]." Medicinski Arhiv, vol. 8, no. 2, 1954, pp. 55-70. STAMBOLOVIC B. [Treatment of chronic adnexitis and parametritis of gonorrheal and septic etiology]. [unboundmedicine.com]
Chronic adnexitis tubercular etiology patients often complaints, characteristic for adnexitis, is not presented, calling for infertility. [medicalency.com]
In cases of suspected tuberculous etiology adnexitis used diagnostic curettage, seeding of menstrual blood, metrosal-pingografiyu, tuberculin test - Mantoux test, Koch. [med-reference.blogspot.com]
Patho physiological mechanisms and etiological factors in male infertility are largely unknown. [books.google.com]
Epidemiology
References:[1][2][3] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Epidemiology[edit] Over one million cases of acute salpingitis are reported every year in the US, but the number of incidents is probably larger, due to incomplete and untimely reporting methods and that many cases are reported first when the illness [en.wikipedia.org]
The epidemiology of Chlamydia trachomatis within a sexually transmitted diseases core group. J Infect Dis. 1996 Apr. 173(4):950-6. [Medline]. Bjartling C, Osser S, Johnsson A, Persson K. [emedicine.com]
Pathophysiology
Pathophysiology Most cases of PID are presumed to occur in 2 stages. The first stage is acquisition of a vaginal or cervical infection. This infection is often sexually transmitted and may be asymptomatic. [emedicine.com]
Prevention
Prevention focuses on preventing abortions, proper management of the postpartum period (infection prevention). [med-reference.blogspot.com]
Preventing adnexitis Optimal PID prevention involves responsibility when choosing sexual partners and safe sex, even though barrier methods of birth control (condom) are not 100% effective against the infection transmission. [penoxal.com]
الصفحة 290 - Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology 1999; 29: 1655-61 6. [books.google.com]
Prevention. The warning adnexitis important role to play in combating crime (outpatient) abortion, prevention of sexually transmitted diseases ( gonorrhoea ), the correct maintenance of the postnatal period (prevention of infections). [medicalency.com]
References
- Lauper U, Schlatter C. Adnexitis and pelvic inflammatory disease. [Article in German] Gynakol Geburtshilfliche Rundsch. 2005;45(1):14-18.
- Diemer T, Gralla O. Male adnexitis. [Article in German] Urologe A. 2008;47(12):1573.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- Biggs WS, Marks ST. Diagnosis and Management of Adnexal Masses. Am Fam Physician. 2016;93(8):676-681.
- Gradison M. Pelvic inflammatory disease. Am Fam Physician. 2012;85(8):791-796.
- Bhavsar AK, Gelner EJ, Shorma T. Common Questions About the Evaluation of Acute Pelvic Pain. Am Fam Physician. 2016;93(1):41-48.