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Pyosalpinx

Pyosalpinx is a condition in which the fallopian tube is filled with pus secondary to acute or chronic inflammation. It leads to constitutional symptoms like fever with chills as well as acute or recurrent lower quadrant pelvic pain which can mimic appendicitis if located on the right side.


Presentation

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].

Constitutional Symptom
  • It leads to constitutional symptoms like fever with chills as well as acute or recurrent lower quadrant pelvic pain which can mimic appendicitis if located on the right side.[symptoma.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]
Hematochezia
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself[nejm.org]
Incontinence
  • Both girls had a history of abdomino-pelvic surgery in childhood for congenital bowel anomalies and fecal incontinence.[ncbi.nlm.nih.gov]
  • Both girls had a history of abdomino-pelvic surgery in childhood for congenital bowel anomalies and fecal incontinence. Such cases… CONTINUE READING[semanticscholar.org]

Workup

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.

Treatment

  • Laparoscopic treatment of acute pyosalpinx, in contrast to radical surgery, preserves reproductive potential and ovarian function.[ncbi.nlm.nih.gov]
  • INTERVENTION(S): Salpingotomy and antibiotic treatment. MAIN OUTCOME MEASURE(S): Successful laparoscopic management of an isolated pyosalpinx in a virgin.[ncbi.nlm.nih.gov]
  • However, the patient presented 8 weeks post-UAE with a pyosalpinx and superinfection of the previously simple fluid collection, requiring treatment with hysterectomy and oophorectomy.[ncbi.nlm.nih.gov]
  • Treatment of the disorder consists of laparotomy and removal of the pus-filled oviduct. Pyosalpinx may be prevented by timely treatment of salpingitis and gonorrhea and by reducing the number of abortions. I. V. I AREMA[encyclopedia2.thefreedictionary.com]
  • Pharmacotherapy of infections Antibiotics or antibacterials are a type of antimicrobial used in the treatment and prevention of bacterial infections.[fertilitypedia.org]

Prognosis

  • Diagnostic procedure s Inspection of the external genitalia PAP-test: the koilocytosis Indicates HPV infection Viral typing: is the search of the viral DNA to identify the subtype and then the prognosis vaccine subtypes 16-18-31-33 Genital herpes - what[brainscape.com]
  • […] 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]

Etiology

  • 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]
  • Chronic adnexitis tubercular etiology patients often complaints, characteristic for adnexitis, is not presented, calling for infertility.[medicalency.com]
  • Inflammatory Diseases Objectives: After completing this section will be able to: describe the various types of inflammatory conditions that involve the fallopian tube indicate etiologic agents and describe pathways of infection describe and identify clinical[med-ed.virginia.edu]
  • Include in heterogeneous group of clinical,Caused by over 25 different etiologic agents of bacterial, viral, and parasitic protozoan , Whose Transmission may occur by vaginal, oral or anal (Therefore, for Both heterosexual and homosexual relationships[brainscape.com]
  • […] also occurs via childbirth, abortion (therapeutic or elective), endometrial biopsy, IUD insertion, miscarriage In 2005, World Health Organization (WHO) estimated 448 million new cases of curable STIs occur annually in individuals aged 15 - 49 years Etiology[pathologyoutlines.com]

Epidemiology

  • A genetic epidemiological study of carcinoma of the fallopian tube. Gynecol Oncol 2001;80:341-5. Ajjimakorn S, Bhamarapravati Y, Israngura N. Ultrasound appearance of fallopian tube carcinoma. J Clin Ultrasound 1988;16:516-8.[ijrcog.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.[medscape.com]
  • 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]
  • Neisseria gonorrhoeae chlamidia trachomatis treponema pallidum N.gonorrhoaea epidemiology Neisseria gonorrhoeae: is the most common STDs, Particularly common in poor countries, for unhygienic conditions and socio-economic N.gonorr etiopathogenesis Etiopathogenesis[brainscape.com]
Sex distribution
Age distribution

Pathophysiology

  • 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

  • Pharmacotherapy of infections Antibiotics or antibacterials are a type of antimicrobial used in the treatment and prevention of bacterial infections.[fertilitypedia.org]
  • Occlusion of the fimbrial end of the tube prevents release of the tubal contents, so that a pyosalpinx may result. E. Reference: Robbins Pathologic Basis of Disease, 6 th ed.[pathology.class.kmu.edu.tw]
  • Pyosalpinx may be prevented by timely treatment of salpingitis and gonorrhea and by reducing the number of abortions. I. V. I AREMA[encyclopedia2.thefreedictionary.com]
  • The program cost and cost-effectiveness of screening men for Chlamydia to prevent pelvic inflammatory disease in women. Sex Transm Dis . 2008 Nov. 35(11 Suppl):S66-75. [Medline] .[medscape.com]

References

Article

  1. Kumar V, Abbas A, Fausto N. Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders; 2014.
  2. Westrom L. Incidence prevalence and trends of acute pelvic inflammatory disease and it consequences in industrialized countries. Am J Obstet Gynecol. 1980;138:880–892.
  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.
  8. Agbor VN, Njim T, Aminde LN. Pyosalpinx causing acute appendicitis in a 32- year old Cameroonina female: a case report. BMC Res Notes. 2016; 9: 368
  9. Paavonen J. Pelvic inflammatory disease. From diagnosis to prevention. Dermatol Clin. 1998;16:747–756.
  10. Ross JD. Is Mycoplasma genitalium a cause of pelvic inflammatory disease?. Infect Dis Clin North Am. 2005 Jun; 19(2):407-13.
  11. Tukeva TA, Aronen HJ, Karjalainen PT, et al. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology. 1999;210 (1): 209-16.
  12. Thomassin-Naggara I, Darai E, Bazot M. Gynecological pelvic infection: what is the role of imaging?. Diagn Interv Imaging. 2012 Jun; 93(6):491-9.
  13. Williams PL, Laifer-narin SL, Ragavendra N. US of abnormal uterine bleeding. Radiographics. 2003; (3): 703-18.
  14. Benjaminov O, Atri M. Sonography of the abnormal fallopian tube. AJR Am J Roentgenol. 2004;183 (3): 737-42.
  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

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Last updated: 2017-08-09 17:54