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].

• 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]

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.

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. IAREMA [encyclopedia2.thefreedictionary.com]

The treatment for chronic malignant obstructions is usually an insertion of a ureteric stent [8]. [cureus.com]

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]

A major point for further investigations is the calculation of prognosis. [ojrd.biomedcentral.com]

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

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]

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]

[…] antigen of Shigella sonnei phase I.J Bacteriol. 1947; 54: 179-181 Jonsson I Monsen T Wiström J A case of Plesiomonas shigeloloides cellulitis and bacteraemia from Northern Europe.Scand J Infect Dis. 1998; 29: 631-632 Kain KC Kelly MT Clinical features, epidemiology [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]

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]

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]

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]

Pharmacotherapy of infections Antibiotics or antibacterials are a type of antimicrobial used in the treatment and prevention of bacterial infections. [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]

Pyosalpinx may be prevented by timely treatment of salpingitis and gonorrhea and by reducing the number of abortions. I. V. IAREMA [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, 6th ed. [pathology.class.kmu.edu.tw]

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

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