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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]
Increased Susceptibility to Infections
  • Therefore, patients with type 2 diabetes mellitus have an increased susceptibility to infection especially when glycemic control is poor.[ncbi.nlm.nih.gov]
Sputum
  • The sputum culture obtained before the beginning of the treatment was negative for Mycobacterium tuberculosis, and the Ziehl–Neelsen stain and the urine cultures (in Löwenstein–Jensen medium and liquid medium) performed in April 2006 were also negative[ncbi.nlm.nih.gov]
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]
Heart Disease
  • Her medical history revealed coronary heart disease and type II diabetes mellitus. She had been a widow for over 20 years, and claimed to have had no sexual relationships since her husband's death.[jmedicalcasereports.biomedcentral.com]
Female Sterility
  • [Female sterility after appendicitis in childhood] Bratisl Lek Listy. 1992; 93 :541–4. [ PubMed ] [ Google Scholar ] Mueller BA, Daling JR, Moore DE, Weiss NS, Spadoni LR, Stadel BV, Soules MR. Appendectomy and the risk of tubal infertility.[ncbi.nlm.nih.gov]
Abdominal Pain with Urination
  • Case presentation A 78-year-old Caucasian woman was admitted to our hospital due to abdominal pain and urination difficulty, along with fever and leucocytosis. On examination the labial majora were fused.[jmedicalcasereports.biomedcentral.com]
Imperforate Hymen
  • 1 Xanthogranulomatous Salpingitis. 38 31433377 2019 2 [Pyosalpinx In A Prepubescent Girl With Hirschsprung's Disease]. 38 Estors Sastre B...Marhuenda Irastorza C 29937305 2019 3 The Dangers of Hymenotomy for Imperforate Hymen: A Case of Iatrogenic Pelvic[malacards.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.

Pneumoperitoneum
  • […] clomiphene citrate administered to prepubertal female rats on development of anovulatory sterility and pyosalpinx. ( 7211091 ) Morishita H....Okada A. 1981 29 Pneumococcal pyosalpinx in a prepubertal child. ( 7451117 ) Casiro O.G....Drachman R. 1980 30 Pneumoperitoneum[malacards.org]

Treatment

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

Prognosis

  • 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]
  • A major point for further investigations is the calculation of prognosis.[ojrd.biomedcentral.com]
  • On the other hand, an “aneurysmal third” is a life-threatening emergency that has an excellent prognosis if managed in a timely fashion. It is a diagnosis that cannot be missed.[reviewofophthalmology.com]
  • 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]

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]
  • The most probable etiological role of M. hominis was established in two clinical cases of PID.[en.aig-journal.ru]
  • 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]

Epidemiology

  • E-mail: guzel.khairullina@gmail.com Tamara Makhova, Junior researcher, Laboratory for Molecular Diagnostics of Reproductive Tract Infections, Central Research Institute of Epidemiology. 111123, Russia, Moscow, Novogireevskaya str. 3a.[en.aig-journal.ru]
  • 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]
  • Epidemiology, clinical features and surgical treatment: evolution over 8 years. 38 Patrelli TS...Modena AB 24050032 2013 33 Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study. 38 Romosan G...Valentin L 23503942 2013[malacards.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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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

  • Pharmacotherapy of infections Antibiotics or antibacterials are a type of antimicrobial used in the treatment and prevention of bacterial infections.[fertilitypedia.org]
  • 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]
  • 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]
  • Preventive Services Task Force. Available at . September 2014; Accessed: February 27, 2019. Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, et al.[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: 2019-07-11 22:33