Pyosalpinx is a gynecological condition in which the fallopian tube becomes distended with pus following acute or chronic inflammation or pelvic inflammatory disease. Although the commonest cause of a pyosalpinx is sexually transmitted infection with N. gonorrhea or C. trachomatis, it can also be caused by enteric bacteria [1] [2] and mycobacterium tuberculosis [3]. Besides sexual intercourse, it can follow abortions, childbirth, pelvic surgeries, placement of intrauterine contraceptive devices, and intra-abdominal infections [2]. Pre-pubertal girls with congenital genitourinary malformations [4] and Hirschsprung disease [5] have been reported to develop pyosalpinx without a prior history of sexual activity.

The patients are usually in the reproductive age group and present in acute cases with lower abdominal pain, fever, nausea, and vomiting. Occasionally, patients present with symptoms of acute abdomen due to rupture of the pyosalpinx with paralytic ileus, bowel obstruction or peritonitis [6]. Acute appendicitis secondary to a gangrenous pyosalpinx has also been reported [7] [8] and can present a diagnostic dilemma. Chronic cases may present with recurrent lower abdominal pain, low-grade fever, malaise, non-specific urinary symptoms, secondary infertility or ectopic pregnancies [9].

• Pain

  The patients are usually in the reproductive age group and present in acute cases with lower abdominal pain, fever, nausea, and vomiting. [symptoma.com]

  Appendicitis 63 year old woman with right lower quadrant pain and elevated white blood cell count Perforated Appendicitis with right pyosalpinx and pyometra Non-pregnant patient with left lower quadrant pain, interpreted as dilated left tube with free [learningradiology.com]

  Case report 2 A 12-year-old virgin female was transferred from an outside hospital with a 4-day history of increasing suprapubic abdominal pain. On the first day of the abdominal pain, a clear/white vaginal discharge was present. [ncbi.nlm.nih.gov]

  Soreness during menstruation and not only in the first or second day; long heavy menstruation, menstrual period ended, and the pain continued to bother; painful ovulation, pain during sexual intercourse, painful form of PMS. [ipf.ua]

  Due to the pain, adnexal palpation was not performed, but tenderness was assumed. [cureus.com]

• Disability

  We report a rare case of acute abdomen due to peritonitis after a ruptured pyosalpinx in an IVF patient who lifted a disabled person. [ncbi.nlm.nih.gov]

  If so, you'll need to disable it when using this site, as it spams the websites you visit with fake requests. You might have the Hola VPN extension installed. [rateyourmusic.com]

  We report a rare case of acute abdomen due to peritonitis after a ruptured pyosalpinx in an IVF patient who lifted a disabled person. Boris Nikolic Khoa Nguyen Nguyen Louis G. [researchgate.net]

  Regardless of the etiology, when ptosis obstructs vision, it is disabling. The appropriate management requires recognition of the underlying cause. This review article highlights the various aspects of ptosis evaluation and management. [kjophthal.com]

• Wound Infection

  endometritis, piosalpinks, sepsis, wound infection (in including the prevention of postoperative anaerobic infections), infections of the skin and soft tissue, pneumonia, empyema, lung abscess, mixed aerobic- anaerobic infections (in combination with [drugstoremg.com]

  It decreases hospital stay, had a lower percentage of wound infection, and had a shorter time for fever to subside. Advantages of open laparoscopic surgery over exploratory laparotomy in patients with tubo-ovarian abscess. [laparoscopyhospital.com]

• Short Stature

  Clinical description During childhood, the disease manifests with short stature, rickets affecting primarily lower extremity deformities. [orpha.net]

• Abdominal Pain

  The patients are usually in the reproductive age group and present in acute cases with lower abdominal pain, fever, nausea, and vomiting. [symptoma.com]

  Regardless of sexual history, pelvic inflammatory disease should be considered in all women with abdominal pain. [ncbi.nlm.nih.gov]

  Pyosalpinx is a complication of PID and a cause of acute abdominal pain misdiagnosed due to similar abdominal emergencies. [ircmj.com]

• Lower Abdominal Pain

  The patients are usually in the reproductive age group and present in acute cases with lower abdominal pain, fever, nausea, and vomiting. [symptoma.com]

  Although pelvic peritonitis, salpingitis and tubo-ovarian abscess are rare following tubal ligation, they should be suspected in any patient presenting with lower abdominal pain. [ncbi.nlm.nih.gov]

  However, they are rarely believed to co-exist The clinical case is of a 33-year-old nulliparous woman who presented with lower abdominal pain and vaginal bleeding following 8 weeks of amenorrhoea. [ajol.info]

  Lower abdominal pain is usually present and bilateral but may be unilateral, even when both tubes are involved. Pain can also occur in the upper abdomen. Nausea and vomiting are common when pain is severe. [merckmanuals.com]

  Common symptoms and signs include lower abdominal pain, cervical discharge, and irregular vaginal bleeding. Long-term complications include infertility, chronic pelvic pain, and ectopic pregnancy. [msdmanuals.com]

• Left Flank Pain

  Presentation Left lower quadrant, suprapubic and left flank pain. White cells count 15.5 (ref. 4.0-11.0) with Neut 12.4 (ref. 2.0-8.0). Patient Data Age: 43-year-old Gender: Female Loading images... [radiopaedia.org]

  flank pain and possible pyelonephritis Enlarged ovaries due to oophoritis and peritoneal inflammation extending along left flank, normal kidneys Hazy fat, hydronephrosis, TOAs, fluid, ileus Inflammation and bilateral tubo-ovarian abnormalities Trans-abdominal [learningradiology.com]

• Abdominal Mass

  There was no palpable abdominal mass or hernia of the abdominal wall. Bowel sounds were present. The rest of her physical exam was unremarkable. [jpss.eu]

• Dyspepsia

  In adolescents and young women, GTB can also present with affectation of the general condition, such as fever or low-grade fever, anorexia and weight loss, ascites, adnexal masses, swelling of the peritoneum, diarrhea, constipation or dyspepsia, and, [ncbi.nlm.nih.gov]

• Papule

  […] cutaneo-mucosa and internal organ involvement Transmission; Cross street Via vertical (transplacental) Primary syphilis chancre caratterizzata is accompanied by satellite adenopathy Secondary syphilis is caratterizzata by the appearance of roseole and papules [brainscape.com]

  Synonyms of Pyoderma Gangrenosum PG General Discussion Pyoderma gangrenosum (PG) is an inflammatory skin disorder that is characterized by small, red bumps or blisters (papules or nodules) that eventually erode to form swollen open sores (ulcerations) [rarediseases.org]

• Salpingitis

  Pyosalpinx (disorder) Synonym for Salpingitis and oophoritis, unspecified N00-N99 Diseases of the genitourinary system (N00-N99)|N70-N77 Inflammatory diseases of female pelvic organs (N70-N77)|N70 Salpingitis and oophoritis|N70.9 Salpingitis and oophoritis [averbis.com]

  A case of salpingitis with pyosalpinx subsequent to tubal ligation is described. The procedure was performed at the time of cesarean section 7 years earlier. [ncbi.nlm.nih.gov]

  […] and oophoritis N70.11 Chronic salpingitis N70.12 Chronic oophoritis N70.13 Chronic salpingitis and oophoritis N70.9 Salpingitis and oophoritis, unspecified N70.91 Salpingitis, unspecified N70.92 Oophoritis, unspecified N70.93 Salpingitis and oophoritis [icd10data.com]

  […] of fallopian tube Fallopian tube abscess Oophoritis Oophoritis (inflammation of the ovaries) Pyosalpingitis Pyosalpingitis (inflammation of fallopian tube with pus) Pyosalpinx Salpingitis Salpingitis (inflammation of fallopian tubes) Salpingitis and [icd9data.com]

  Pyosalpinx an accumulation of pus in an oviduct, usually resulting from acute salpingitis. [encyclopedia2.thefreedictionary.com]

• Dyspareunia

  piosalpinks (pus-filled mass of the fallopian tube), complete or partial obstruction of the fallopian tubes and infertility, tubal-ovarian abscesses, pelvioperitonit, adhesions in the pelvic cavity and the abdominal cavity, chronic pelvic pain and dyspareunia [ipf.ua]

  The inflammation commonly becomes chronic and patients present with pelvic mass and dyspareunia. Most cases occur in young, sexually active women, although 1-2% of tubo-ovarian abscesses are reported in postmenopausal women. [med-ed.virginia.edu]

  النفاس Adnexa ملحقات الرحم artresia فتح -رتق choriocarcinoma المشيمة fibroids الأورام الليفية infertility عقم hormonal contraception وسائل منع الحمل الهرمونية oral contraceptive مانع الحمل عن طريق الفم corpus luteum الجسم الأصفر في مبيض الانثى البالغه dyspareunia [quizlet.com]

  Occasionally, dyspareunia or dysuria occurs. Many women with inflammation that is severe enough to cause scarring have minimal or no symptoms. [merckmanuals.com]

  Usually asymptomatic, it can still cause a compression pelvic pelvic pain croncio dyspareunia Syndrome Fitz-Hugh-Curtis: It can be a complication of gonococcal salpingitis or Chlamydia and is caratterizzata by pain in the right upper quadrant association [brainscape.com]

• Cesarean Section

  The procedure was performed at the time of cesarean section 7 years earlier. The pyosalpinx included the distal portion of the ligated tube, with no evidence of infection in the proximal segment. [ncbi.nlm.nih.gov]

  Quite often formation of a piovar is preceded by carrying out various gynecologic operations: a vaginal hysterectomy, a resection of an ovary, a scraping of a cavity of a uterus, abortion (especially criminal abortions), Cesarean section, bandaging of [medicine-for-you.com]

  The mean BT was similar between the pyosalpinx and TOA groups, although the patients with TOA had Table 1 Sociodemographic characteristics Age (years) Parity Abortion Married Occupation Cesarean section Previous pelvic surgery Previous PID Contraception [docksci.com]

   Gynecological causes Pelvic inflammatory disease (PID) Endometritis Salpingitis Tubo-ovarian abscess Fitz-Hugh-Curtis Syndrome Puerperal infections Cesarean section Vaginal delivery Post-operative gynecological surgery Pelvic abscess Post leiomyomas [slideshare.net]

• Flank Pain

  Presentation Left lower quadrant, suprapubic and left flank pain. White cells count 15.5 (ref. 4.0-11.0) with Neut 12.4 (ref. 2.0-8.0). Patient Data Age: 43-year-old Gender: Female Loading images... [radiopaedia.org]

  Smith RC, Verga M, McCarthy S, Rosenfield AT: Diagnosis of acute flank pain: value of unenhanced helical CT. [cureus.com]

  pain and possible pyelonephritis Enlarged ovaries due to oophoritis and peritoneal inflammation extending along left flank, normal kidneys Hazy fat, hydronephrosis, TOAs, fluid, ileus Inflammation and bilateral tubo-ovarian abnormalities Trans-abdominal [learningradiology.com]

Based on the clinical presentation, the workup in patients with pyosalpinx must be rapid in the emergency room and gradual in chronic cases. But in all patients, the workup begins with a detailed history and physical examination. Menstrual and sexual history are vital to detect the etiology while physical examination will reveal a tender adnexal mass in a febrile patient. A wet mount preparation for trichomoniasis [10] [11] and cervical cultures for gonorrhea and chlamydia must be obtained during the pelvic examination.

A pregnancy test is mandatory in all patients to rule out pregnancy, especially as ectopic pregnancy can mimic the presentation of a pyosalpinx. A complete blood count will reveal leukocytosis with elevated erythrocyte sedimentation rate and C-reactive protein levels. Other tests ordered include urinalysis, serology for syphilis, human immunodeficiency virus (HIV) and hepatitis B.

The radiological mainstay of the workup is ultrasonography. Findings include distended fallopian tubes with >5mm thickness, multiple ovarian cysts, endometrial borders which are indistinct and free fluid in the pelvis especially in acute cases [12]. On transvaginal ultrasonography, a pyosalpinx can be differentiated from a hydrosalpinx due to its higher protein content giving rise to low echo levels [13] [14]. On magnetic resonance imaging (MRI), an hydrosalpinx and a pyosalpinx can appear identical [15] [16] although the pyosalpinx tends to have thickened walls [11] with hyperenhancement surrounded by inflammation.

The gold standard for diagnosis of a pyosalpinx is laparoscopy as it is more specific and sensitive than the clinical criteria and is a means to drain the pus for microbiological assessment and culture.

• Chlamydia

  The role of spermatozoa in the pathogenesis of Chlamydia trachomatis salpingitis in a primate model. Sex Transm Dis. 1993 Jul-Aug. 20(4):214-9. [Medline]. Paavonen J. Chlamydia trachomatis infections of the female genital tract: state of the art. [medscape.com]

  Chlamydia infection A common sexually transmitted disease (STD) caused by the Chlamydia trachomatis bacteria that can lead to serious reproductive morbidity. [fertilitypedia.org]

  The swab revealed the presence of Escherichia coli only, without evidence of other bacteria such as Chlamydia. With antibiotic treatment, the infection was adequately treated, and the patient was discharged in a healthy condition. [ncbi.nlm.nih.gov]

  PID is an infection of the female reproductive tract that is caused by sexually transmitted diseases (STDs) like chlamydia and gonorrhea. Other types of infections, including tuberculosis, can also cause this complication. [healthline.com]

• Neisseria Gonorrhoeae

  The most important causative micro-organisms are Chlamydia trachomatis, Neisseria gonorrhoeae, and micro-organisms associated with bacterial vaginosis. [scienceopen.com]

  The sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis are common causes of PID, but infection is often polymicrobial. [merckmanuals.com]

  Diagnosis includes PCR of cervical specimens for Neisseria gonorrhoeae and chlamydiae, microscopic examination of cervical discharge (usually), and ultrasonography or laparoscopy (occasionally). Treatment is with antibiotics. [msdmanuals.com]

  The main bacterial species that are responsible are Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and E. coli. [achaiki-iatriki.gr]

  E. coli), Gardnerella vaginalis, Haemophilus influenza, Mycoplasma, Neisseria gonorrhoeae, rarely other anaerobic and aerobic bacteria, Staphylococcus, Streptococcus, Trichomonos vaginalis, Ureaplasma urealyticum Also Herpes and CMV, fungi, parasites [pathologyoutlines.com]

Laparoscopic treatment of acute pyosalpinx, in contrast to radical surgery, preserves reproductive potential and ovarian function. [ncbi.nlm.nih.gov]

N/A Laparoscopic Treatment Of Acute Pevic Inflamation... Nabil Moulay Specialty: Gynecology views: 6082 comments: 0 N/A The author of this video presents laparoscopic treatment of acute pevic inflamation disease. 03min 44s. [medtube.net]

A.: Frequency, Causes, Prognosis and Treatment of Rupture of Salpinx., Thèse de Hambourg Lübke K.A. Zentralbl. Gynäk. 1925; (): 2423 Mann E.C. Am. J. Obst. 1907; 56: 461 Martin A. [ajog.org]

[…] with obstruction and distention with pus General Features CT Findings MR Findings Ultrasonographic Findings Imaging Recommendations General Features Gross Pathologic & Surgical Features Microscopic Features Presentation Demographics Natural History & Prognosis [app.statdx.com]

Prognosis With treatment, prognosis is very good: growth is normalized and skeletal deformities can be corrected. The documents contained in this web site are presented for information purposes only. [orpha.net]

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]

Chronic adnexitis tubercular etiology patients often complaints, characteristic for adnexitis, is not presented, calling for infertility. [medicalency.com]

In patients over 55 years, the etiology is most likely microvascular and occurs in vasculopaths (hypertensives, diabetics). [reviewofophthalmology.com]

Unilateral damage of a uterine tube is characteristic of a septic etiology. [medicine-for-you.com]

Menstrual and sexual history are vital to detect the etiology while physical examination will reveal a tender adnexal mass in a febrile patient. [symptoma.com]

E-mail:[email protected] Tatiana Rumyantseva, PhD, Gynecologist, Research officer, Clinical Diagnostoc Center, Central Research Institute of Epidemiology. 111123, Russia, Moscow, Novogireevskaya str. 3a. [en.aig-journal.ru]

Scand J Infect Dis. 1998; 29: 631-632 Kain KC Kelly MT Clinical features, epidemiology and treatment of Plesiomonas shigelloides diarrhea. [clinicalmicrobiologyandinfection.com]

Summary Epidemiology To date, only 34 patients with PAPA syndrome have been reported worldwide, from five families (two in the USA, one in Italy, one in the Netherlands, and one in New Zealand). [orpha.net]

Definition / general Inflammation of fallopian tube, most commonly sexually transmitted due to chlamydia and gonorrhea Terminology Part of spectrum of pelvic inflammatory disease (PID) Epidemiology > 1 million cases of acute salpingitis reported annually [pathologyoutlines.com]

Identification of the underlying pathophysiologic mechanism is paramount to institute proper treatment. Pathophysiology Ptosis is the result of dysfunctioning of one or both upper eyelid elevator muscles. [emedicine.medscape.com]

Obstet Gynecol 2010 PID PATHOPHYSIOLOGY Beyond the pelvis 7.  Less commonly: - Direct spread from nearby appendicitis or diverticulitis - Hematogenous, lymphatic, peritoneal spread: TB salpingitis PID 8. 70% • N. Gonorrhoeae • C. [slideshare.net]

The pathophysiological mechanism is believed to be chronic inflammation and/or irritation of the vulvar skin arising from various conditions such as local inflammation [1], lichen sclerosus [2], recurrent urinary tract infections [3] as well as lack of [jmedicalcasereports.biomedcentral.com]

Pathophysiology of TOA Ascending bacterial infection originating in the uterus Extending to the fallopian tube and broad ligament Acute supprative salpingitis, salpingo-oophoritis, pyosalpinx Tuboovarian complex or tuboovarian abscess [7]. [laparoscopyhospital.com]

Prevention To reduce your risk of pelvic inflammatory disease. Efforts to prevent the disease include not having sex or having few sexual partners and using condoms. [fertilitypedia.org]

Prevention of a piosalpinks in gynecology dictates need of timely treatment of salpingit, STD exceptions (gonorrhoeas, clamidiosis, mycoplasmosis, etc.), preventions of abortions, post-operational and postnatal complications. [medicine-for-you.com]

Prevention focuses on preventing abortions, proper management of the postpartum period (infection prevention). [med-reference.blogspot.com]

PREVENTION Preventing PID and its sequelae can take place on three levels -- primary, secondary, and tertiary prevention (37). Primary prevention involves avoiding acquisition of sexually transmitted infections. [cdc.gov]

How can it be prevented? Ptosis cannot be prevented, but it can be easily detected in its early stages. It is also possible to act before the visual field becomes affected and before the unsightly effect worsens. [imo.es]

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3. Gascon J, Acien P. Large bilateral tubercular pyosalpinx in a young woman with genitourinary malformation: a case report. J Med Case Rep. 2014; 8: 176
4. Moralioğlu S, Ozen IO, Demiroğullari B, Başaklar AC. Pyosalpinx and hydrosalpinx in virginal adolescents: report of two cases. West Indian Med J. 2013;62:257–259.
5. Desai B, Ward T. Bilateral pyosalpinx in a peripubescent female with Hirschsprung’s disease: a case report. Int J Emerg Med. 2011;4:64.
6. Evans LAJ. Rupture of a pyosalpinx associated with an intra-uterine pregnancy. Proc R Soc Med. 1955;48:1090.
7. Jackson H. Torsion of a pyosalpinx. Br Med J. 1951;4726:299.
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15. Hamm B, Krestin G, Laniado M, et al. MR Imaging of the Abdomen and Pelvis. Thieme Medical Pub; 2009
16. Del Frate C, Girometti R, Pittino M, et al. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006; 26(6):1705-18