Hydrosalpinx - is it possible to do without surgery? Basic diagnostic methods

Update: October 2018

One of the unpleasant consequences of inflammation of the appendages, in particular the fallopian tubes, is hydrosalpinx. According to statistics, this pathology occurs in 10–30% who are faced with the problem of pregnancy, since hydrosalpinx interferes with successful conception.

But with timely and adequate treatment, the onset of a long-awaited pregnancy is quite possible, so you should not try to get rid of this disease on your own, this only aggravates the pathological process and delays the wait for the joyful moment - the birth of a child.

Hydrosalpinx: what is it?

Hydrosalpinx is a disease of the fallopian tubes that results in disruption of their patency. The name of the pathology comes from Latin words, where “Hydro” is translated as liquid, and “salpinx” means pipe. The phrase often used by women - hydrosalpinx of the tubes - is incorrect, just like oilseed oil. A feature of the disease is the accumulation of fluid (transudate) in the lumen of the fallopian tube due to blockage of the internal and external openings of the oviduct, as a result of which it turns into a saccular formation.

There are:

• right-sided hydrosalpinx;
• hydrosalpinx on the left;
• bilateral hydrosalpinx.

It is incorrect to use such combinations as acute and chronic hydrosalpinx. This pathology is a complication of the inflammatory process of the fallopian tubes - salpingitis, which can be both acute and chronic.

An example of a diagnosis: Acute bilateral salpingoophoritis. Bilateral hydrosalpinx.

A little anatomy and physiology

The fallopian tube (synonyms: fallopian tube or oviduct) is a paired organ and is presented as a hollow tube with two lumens. The length of the oviduct reaches 10–12 cm, with the right tube being slightly longer than the left. One end of the oviduct opens into the uterine cavity, and the other ends with fimbriae (villi) and opens into the abdominal cavity, near the ovary. Through these openings, the abdominal cavity communicates with the woman's internal and external genitalia, which increases the risk of ascending infection, for example, with vaginitis.

The wall of the oviduct consists of three layers:

• external – represented by the peritoneum and protects the pipe from negative influences;
• muscular - formed by muscle fibers and thanks to which the tube makes peristaltic (contractile) movements towards the uterine cavity;
• internal, covered with ciliated epithelium, the cilia of which move in waves (flicker), which facilitates the movement of the fertilized egg towards the uterus; in addition, the glands located in the mucous layer of the tube produce a secretion that maintains the constancy of the internal environment of the oviduct and the viability of the egg, sperm and zygote.

The role of the fallopian tubes

The oviducts are essential for successful conception and implantation of a fertilized egg in the uterus. The functions of the fallopian tubes include:

• with the help of the fimbriae of the funnel of the tube, the matured egg released from the follicle is captured (the moment of ovulation);
• the egg moves to the ampullary section of the tube, where sperm are delivered from the uterine cavity;
• maintaining the viability of germ cells (sperm and eggs), preparing for their union, direct fertilization;
• maintaining the vital activity of the fertilized egg (zygote) in the tube until it moves into the uterine cavity;
• transportation of the zygote into the uterine cavity due to peristalsis of the oviducts and increased activity of the cilia of the ciliated epithelium.

The mechanism of pathology development

Impaired functioning of the fallopian tubes occurs due to inflammation, for example, against the background of salpingitis or salpingoophoritis. As a result, connective tissue begins to grow and scars and adhesions form. The inflammatory process and adhesions affect all layers of the oviducts, with varying degrees of severity.

The villi of the ciliated epithelium die, and the muscle layer stops contracting (peristalsis disappears). Adhesions grow in the lumen of the fallopian tube, which impairs its patency, and the fimbriae of the funnel of the tube stick together. When the adhesions close both openings of the oviduct, mucus begins to accumulate in the resulting closed space, intensely, due to inflammation, produced by the glands of the epithelium of the inner layer of the tube. As a result, the tube expands, forming a hydrosalpinx or sactosalpinx. When the serous-mucosal contents of the tube suppurate, a pyosalpinx is formed.

In some situations (incomplete fusion of the fimbriae), a “ventilated hydrosalpinx” is formed, which periodically breaks through due to the pressure of the accumulated fluid. An increase in pressure occurs with a sudden change in body position, straining, or during hysterosalpingography. In this case, the transudate flows into the pelvis. Emptying of the oviduct with “ventilated hydrosalpinx” occurs systematically. The overflowing inflammatory fluid stimulates the formation of adhesions in the pelvis - a vicious circle is formed that maintains the existence of hydrosalpinx.

Causes of hydrosalpinx

The formation of hydrosalpinx is caused by the closure of the ampullary (middle) part of the fallopian medium, which is facilitated by a local infectious-inflammatory reaction. Infectious agents can penetrate into the cavity of the oviduct both ascendingly, from the underlying organs of the reproductive system (cervix, vagina, uterus), and descendingly through the bloodstream (bladder and kidneys, tonsils and intestines, appendix and others). Inflammation can be aseptic and occur in the presence of other gynecological diseases. The formation of hydrosalpinx occurs due to the following reasons:

• inflammation of the tubes, ovaries or appendages (salpingitis, oophoritis, adnexitis);
• inflammation of the uterus (endometritis);
• frequent and random change of sexual partners (sexually transmitted infections: chlamydia, myco- and ureaplasma, trichomonas, gonococci and others);
• tuberculosis of the female genital organs;
• wearing an intrauterine contraceptive;
• frequent hypothermia (weaken the immune system and activate opportunistic flora);
• abortions and diagnostic curettage of the uterine cavity;
• long-term vaginitis and vaginal dysbiosis;
• inflammation of the cervix and cervical canal;
• external endometriosis (causes aseptic inflammation and the formation of adhesions in the pelvis);
• adenomyosis;
• myomatous node in the area where the fallopian tube enters the uterine cavity;
• sexual infantilism (pipes are thin, long and crooked);
• damage to the oviducts during laparoscopy with the subsequent occurrence of aseptic inflammation.

The following factors predispose to the formation of a saccular formation in the pipe:

• neglect of the rules of intimate hygiene;
• stress, emotional stress;
• endocrine pathology: diabetes mellitus, thyroid diseases (weaken the body’s defenses).

But I would like to note that not always suffered and treated salpingitis or adnexitis ends in the formation of hydrosalpinx. With strong immunity and adequate and timely treatment, the inflammatory process in the tube disappears without consequences.

Symptoms

The clinical picture of the described pathology depends on the disease that caused it. With hydrosalpinx, which developed against the background of acute inflammation of the tubes, the symptoms are more pronounced. The patient is worried about febrile temperature, sharp, bursting pain in the groin (left or right), signs of intoxication: loss of appetite, lethargy and weakness. With the rapid accumulation of transudate in the ampullary section of the tube, the pain is bursting and pulsating.

In the case of chronic salpingitis, accompanied by the formation of hydrosalpinx, patients are often not bothered by anything. Often the only complaint is the inability to get pregnant, and hydrosalpinx is discovered during additional examination. But complaints of discomfort in the iliac regions, sensation of a foreign body in the groin, etc. are also possible. If there is ventral hydrosalpinx, then the woman may notice periodic heavy watery discharge from the genital tract (in the event of a rupture of the formation into the uterine cavity). When transudate spills into the pelvic cavity, adhesions increase in it, which is manifested by chronic pelvic pain syndrome. Sometimes the symptoms of saccular tube formation resemble acute surgical pathology (appendicitis, renal colic or intestinal colic).

Typical signs of chronic salpingitis and formed hydrosalpinx are:

• discomfort or slight aching pain in the iliac region/areas;
• menstrual disorders;
• pathological discharge from the genital tract;
• absence of pregnancies.

Pregnancy due to hydrosalpinx

It is possible to become pregnant due to hydrosalpinx, but only if the tube is damaged on one side. Accordingly, the likelihood of conception is reduced by 50%. However, with this disease, the risk of tubal pregnancy and spontaneous abortion increases. Ectopic pregnancy is caused by damage to the ciliated epithelium in the affected tube and disruption of its peristalsis. As a result, the fertilized egg lingers in the oviduct for 4 or more days, where it implants and continues to develop.

Spontaneous termination of pregnancy due to saccular expansion of the tube is explained by several points:

• mechanical effect: periodically pouring fluid from the ventral hydrosalpinx washes the zygote from the surface of the endometrium, preventing it from implantation;
• the inflammatory transudate of the hydrosalpinx, entering the uterine mucosa, causes its damage and the development of endometritis, which makes implantation of the embryo impossible;
• there may be a toxic effect of the inflammatory fluid on the embryo, which leads to its damage and death;
• the sensitivity of endometrial receptors to female sex hormones decreases, which leads to disruption of the hormonal regulation of the uterine mucosa during the implantation process.

If hydrosalpinx is diagnosed on both sides, then pregnancy cannot occur naturally. In such cases, they resort to assisted reproductive technologies (IVF), although the effectiveness of in vitro fertilization and subsequent gestation is reduced several times (2 – 5).

If pregnancy nevertheless occurs against the background of an existing saccular expansion of the tube, then it can terminate spontaneously in the early and late stages. Therefore, all pregnant women with hydrosalpinx are at high risk for miscarriage. Treatment of the disease is postponed until the postpartum period.

Diagnostics

Diagnosis of this complication begins with a gynecological examination. When performing bimanual palpation, hydrosalpinx can be felt as a tight-elastic and elongated formation on the right/left or on both sides. There may be minor pain on palpation of the appendage area or no pain at all. But with a slight expansion of the oviduct, the doctor may not palpate the formation and prescribe additional research methods:

Ultrasound with transvaginal sensor

The presence of a saccular formation on one or both sides, located between the uterus and the ovary, its size and shape are determined. It is possible to visualize the septa in the formation (follicular hydrosalpinx). The formation is filled with hypoechoic fluid and has its own thick capsule.

Hysterosalpingography

This method consists of introducing a contrast agent (under pressure) into the uterine cavity through the cervical canal. Then x-rays are taken. Hysterosalpingography allows you to determine the patency of the tubes - contrast is visualized in the pelvis and identify hydrosalpinx. If there is a complication, the fallopian tube looks tortuous and thickened, and accumulated contrast is found in the enlarged ampullary section.

Laparoscopy

Carried out for diagnostic and therapeutic purposes. During laparoscopic surgery, thickened fallopian tubes are revealed, the fimbriae at their ends are swollen and hyperemic, and the wall of the tube is thinned and translucent, its cavity is filled with watery contents.

In addition to instrumental examination methods, it is necessary to be tested for sexually transmitted infections (chlamydia, myco- and ureaplasma, cytomegalovirus, HPV and herpes virus).

Treatment

If hydrosalpinx is detected, a woman is strongly recommended to undergo treatment, because the longer this pathology exists, the more intensively adhesions form in the pelvis, which reduces the chances of conception and increases the risk of miscarriage or ectopic pregnancy. Unfortunately, many patients think of this disease as not serious (it doesn’t hurt, so it’s not dangerous) and delay their visit to the gynecologist. Sometimes this leads to irreversible consequences: the absolute impossibility of conceiving naturally and the need to resort to IVF.

But how to treat this pathology? Treatment for hydrosalpinx is carried out in two stages. The first stage of treatment is conservative therapy. If there is an acute inflammatory process of the appendages or an exacerbation of a chronic one. First of all, antibiotic treatment is prescribed. The duration of the course and dosage of antibacterial drugs are selected individually, taking into account the identified pathogens and their sensitivity to drugs.

The main line of conservative therapy is stimulation of the immune system. For this purpose, immunomodulatory agents are prescribed:

• immunofan;
• lycopid;
• imudon;
• Thymalin;
• taktivin;
• aloe injections;
• immunal;
• autohemotherapy (intramuscular injection of a woman’s own venous blood).

Also, to stimulate the immune system, taking and parenteral administration of vitamins is indicated. Physiotherapeutic procedures are widely used, although it is impossible to achieve complete cure of hydrosalpinx and resorption of adhesions with their help:

• magnetophoresis;
• electrolytes (calcium, magnesium);
• electrical stimulation of the fallopian tubes;
• endovaginal vibration massage.

Hirudotherapists are confident that it is possible to get rid of this disease by resorting to the method of treatment with leeches. Such a statement has no basis in scientific evidence or confirmed statistical data.

Traditional methods

Most patients believe that hydrosalpinx can be treated with folk remedies. Doctors allow the use of traditional methods, but only as an addition to the first (conservative) stage of therapy. Traditional medicine will not help get rid of the disease, but will only eliminate a number of symptoms: they will reduce pain, somewhat slow down the progression of inflammation and adhesions, and more or less normalize the menstrual cycle. Among the recommended folk remedies, it is permissible to use:

• taking pumpkin, potato and nettle juice (separately or in a mixture);
• microenemas with medicinal herbs (chamomile, calendula, oak bark);
• taking a mixture of aloe leaves, butter and honey;
• taking oat infusion;
• taking juniper baths (an infusion of berries and juniper branches is poured into the water; the water in the bath should be warm, but not hot);
• infusion of adonis;
• infusion of a mixture of herbs (chamomile, currant leaf, sage, St. John's wort).

Once again, I would like to remind you that it is impossible to achieve a complete cure of the disease using traditional medicine methods.

Surgery

The second stage of treatment for this complication is surgical intervention. If hydrosalpinx is present, treatment without surgery does not make sense. As long as the focus of inflammation remains in the pelvis, adhesions will continue to form, pain will persist and the chances of fertilization will decrease.

Today, laparoscopy is used as a surgical intervention for hydrosalpinx. Laparoscopic treatment of saccular formation in the tube is the most gentle and effective surgical intervention. During laparoscopy, depending on the condition of the tubes, the age of the patient and her desire to become pregnant, the following types of surgical intervention in the anatomy of the oviduct are performed:

• salpingo-ovariolysis - adhesions around the oviduct and ovary are dissected, their anatomical location is restored, and adhesions in the lumen of the fallopian tube are also separated;
• fimbryolysis and fimbryoplasty – the fimbriae of the final section of the tube, which are adjacent to the ovary, are freed from adhesions, the inflammatory transudate is removed from the tube, and, if necessary, fimbriae plastic surgery is performed;
• salpingostomy and salpingoneostomy - they form a new hole in the ampullary section of the oviduct or are freed from adhesions of the anatomical hole (minus salpingoneostomy - the new hole closes very quickly);
• tubectomy – removal of a tube/tubes (performed in women over 35 years of age or if it is impossible to restore the patency of the oviduct and eliminate hydrosalpinx).

But even in the case of a successful operation, preserving the tube and restoring its patency, the oviduct does not function as before. The villi of the ciliated epithelium either lose mobility, or the epithelium itself atrophies, and the muscle layer is not able to contract as before, that is, the peristalsis of the tube is disrupted, so patients are included in the risk group for ectopic pregnancy, and pregnancy is recommended through IVF.

Question answer

How dangerous is this disease?

The presence of hydrosalpinx increases the likelihood of an ectopic pregnancy several times. In addition, hydrosalpinx almost always leads to infertility. A saccular formation in the pipes that increases in volume may burst or fester (pyovar).

Are there any restrictions necessary for this disease?

Yes, definitely. Firstly, physical activity should be avoided (vibration, straining, sudden changes in body position: somersaults, bending, jumping). Secondly, avoid excessive activity during sexual intercourse, which increases pain. In addition, it is not recommended to sunbathe and visit a solarium, as well as visiting baths, saunas and taking hot baths, which can provoke an exacerbation of the inflammatory process. It is undesirable to swim in the pool and open reservoirs, as local hypothermia will also provoke an exacerbation. It is prohibited to drink alcohol, including low-alcohol drinks, which suppresses the immune system.

What is the prognosis for pregnancy after laparoscopic surgery for this disease?

With the patency of the tube restored and the hydrosalpinx removed, conception naturally and pregnancy occurs in 60–75%, and the probability of an ectopic pregnancy does not exceed 5%. If the tube is removed, the effectiveness of IVF is 30 – 35%.

For 3 to 4 weeks it is necessary to refrain from physical activity and observe sexual rest. You should also follow a diet that limits the consumption of spicy, pickled and salty foods, fried and fatty foods, fast food and canned food.

Hydrosalpinx is a complication of salpingitis (inflammation of the appendages), leading to infertility. Other reasons can also cause pathology - hormonal imbalances, stress, hypothermia, so the disease is very common.

Appointment with a gynecologist - 1000 rubles. Comprehensive pelvic ultrasound - 1000 rubles. Appointment based on ultrasound or test results - 500 rubles (optional)

What is hydrosalpinx

Hydrosalpinx is an accumulation of fluid in the lumen of the fallopian tube. At the site of inflammation, a sac with serous fluid inside is formed. The capsule blocks the lumen of the fallopian tube and prevents fertilization and conception.

Causes

The main reason for the formation of hydrosalpinx is (salpingitis). Complications are almost guaranteed in the presence of factors such as:

• Hypothermia. It provokes activation of opportunistic microflora and weakening of the body's protective functions. The result is the formation of pus in the appendages.
• , against the background of which it worsens .
• And (during curettage, the appendages are damaged and infection occurs).
• Surgeries on the uterus and ovaries (later scars and adhesions occur).
• Infections of the genitourinary area (provoke an inflammatory process in neighboring organs).
• An unsuccessfully installed intrauterine device.
• Violent sex life without protection ( - provocateurs of many diseases of the female genital area).
• (inflammation of the uterus).
• near the appendages (the formation puts pressure on the fallopian tubes, causing adhesions)
• Adhesions in the pelvic area (the main cause of hydrosalpinx).
• Violation of the vaginal microflora (the infection is transferred to the uterus and spreads through the fallopian tubes).
• The cause of hydrosalpinx on the right is chronic or acute appendicitis.

Factors that cause hydrosalpinx also include (diabetes, thyroid pathology), severe or constant stress, constant hypothermia (exercise on ice, in cold water).

Types of disease and pregnancy prognosis

The disease is classified based on the following factors.

Liquid composition:

• A simple accumulation of serous fluid is a hydrosalpinx.
• The presence of pus impurities - pyosalpinx.
• The presence of blood impurities inside the formation is hematosalpinx.
• A neoplasm in the fallopian tube with contents inside is a sactosalpinx.

By location:

• Left-sided hydrosalpinx of the ovary, in which the patency of the left-sided fallopian tube is disrupted - occurs most often. In this case, fertilization occurs in a healthy right appendage. In the acute course of the disease, the symptoms are pronounced: the temperature rises, the state of health worsens, and pain in the lower abdomen occurs.
• Right-handed. Hydrosalpinx on the right side differs from the left side only in its location.
• Bilateral hydrosalpinx. A consequence of prolonged inflammation and the formation of adhesions. It significantly increases the risk of infertility because it blocks the normal circulation of serous fluid in the appendages.

According to symptoms and duration of treatment:

• Acute, with bright signs.
• Chronic. If the disease is not treated, the severity of the symptoms will subside, and the patient will be diagnosed with chronic hydrosalpinx.

According to the form of the neoplasm:

• tubular;
• bell-shaped;
• oval;
• irregular shapes.

According to morphological features:

• Simple(the formation is a single capsule with liquid inside).
• Follicular hydrosalpinx. INis expressed in multiple formations inside the fallopian tube, filled with fluid and not interconnected (capsules of different sizes and shapes, separated from each other by partitions 1-4 mm thick). Pain on the right side is sometimes perceived as an attack of appendicitis, and the patient does not immediately seek help. Follicular hydrosalpinx requires surgical intervention.
• Valve(with partial release of fluid mixed with mucus, when adhesions periodically break through).

Vent hydrosalpinx of the left tube is a variant of chronic pathology. It also occurs on the right side, but is more often left-sided. It is formed in cases where the adhesive process does not block the lumen of the appendage, and the adhesions themselves remain soft and elastic. Under the pressure of the accumulating serous fluid, the hydrosalpinx cavity stretches and bursts, and the contents pour into the pipes and from there into the vagina. A woman recognizes this by watery discharge and acute pain in the lower abdomen.

If the size of the ruptured capsule is small, then the ventilated form of the disease does not cause discomfort, although the problem must be eliminated.

Symptoms of hydrosalpinx

Statistics show that women are more often diagnosed with hydrosalpinx on the left, the symptoms of which force the patient to seek medical help. Hydrosalpinx on the right may not bother you until the symptoms indicate an acute course of the disease.

The disease is especially dangerous if hydrosalpinx forms in both fallopian tubes. The causes of hydrosalpinx on the right are the same as on the left, but bilateral lesions are more often the result of unsuccessful surgical intervention. With unilateral hydrosalpinx, you can get pregnant safely, but bilateral pathology is almost 100% infertile.

Sometimes the neoplasm develops asymptomatically, and the patient begins to worry when she has problems conceiving. It is easier to notice a disease caused by inflammation of the fallopian tubes. Symptoms of inflammation:

• Intoxication of the body (fever, weakness, nausea, headache).
• When hydrosalpinx occurs in an acute form, the temperature rises to 38-39 C. Also, a constant temperature within 37-37.50 C should be alarmed if there is a failure of menstruation and pain is felt in the lower abdomen. This is how the chronic form of the disease proceeds.

Symptoms of hydrosalpinx on the right and left:

• The patient notes from the vagina (a sign of unilateral or small hydrosalpinx, due to which the serous fluid partially passes through the fallopian tubes and flows out through the vagina).
• (the problem affects the functioning of the ovaries).
• , having a pulsating character. Unpleasant sensations andlower abdominal painafter sexual intercourse.

Feedback from patients indicates that the symptoms of hydrosalpinx in the chronic form are less pronounced or absent.

Symptoms of bilateral hydrosalpinx

The signs of hydrosalpinx on the right are similar to how hydrosalpinx manifests itself on the left, but the symptoms of a bilateral neoplasm are pronounced. In addition to lethargy and fever, the patient feels nagging or aching pain on both sides of the abdomen; they are bursting, “cramping” in nature. The sensations are similar to those that a woman experiences before the onset of menstruation.

Signs of hydrosalpinx rupture

The growing tumor causes anxiety, causing unusual pain in the projection of the ovaries, copious watery discharge and increased temperature. If these symptoms remain unattended, since the patient may attribute them to PMS, constipation, poor diet, change of weather, etc., the formation reaches a large size and the bubble with pus bursts.

Hydrosalpinx will also burst if conservative treatment does not help. This happens with late treatment, weak immunity, and incorrectly selected medications.

Symptoms of a hydrosalpinx rupture are as follows:

• Sharp, unbearable pain below the navel on one or both sides of the abdomen, of a cramping, pulsating nature.
• Severe pain during sexual intercourse.
• Vaginal fluid
• A sharp deterioration in health, short-term loss of consciousness.

The condition is very dangerous, since when serous fluid enters the abdominal cavity, peritonitis begins - purulent inflammation in the abdominal cavity.

In such a situation, the patient develops tachycardia against the background of severe pain, so during the initial examination at the site, a hydrosalpinx rupture can be mistaken for a myocardial infarction. The abdominal muscles tense and relaxation does not occur, even if the patient lies on her back.

Diagnosis of hydrosalpinx rupture is complicated by the syndrome of imaginary well-being, which consists of the following: at first a person feels a sharp pain, then the peritoneal receptors adapt and stop sending alarming signals to the brain. The woman decides that she has a spasm, which has passed. She calms down, but after 1-2 hours the attacks repeat with renewed vigor.

An equally dangerous consequence of hydrosalpinx rupture is sepsis - the entry into the blood of pus and serous fluid from the ruptured sac. The rupture is accompanied by both an increase and a decrease in body temperature. The heartbeat quickens, sweat appears on the forehead. A blood test shows an abnormal increase in white blood cells in the blood. The danger is septic shock, which in every second case leads to death.

Hydrosalpinx and other diseases: ovarian cyst, bacterial vaginosis, endometriosis

Between diseases and hydrosalpinx - direct connection. The fact is that a left ovarian cyst is often caused by an infection coming from the intestines. If a woman is hypothermic, her immune system is weakened, the infection passes from the intestines to the ovary, and from there it can spread to the fallopian tubes.

This also applies to vaginal infections, which freely reach the uterus and from there spread to the appendages, causing hydrosalpinx.

IN Where a woman is diagnosed with bilateral hydrosalpinx, a right ovarian cyst or endometriosis is often discovered. The disease usually develops against the background of an existing infection. This provokes inflammation and loss of peristalsis of the fallopian tubes. Serous fluid accumulates in them, which leads to the death of the ciliated epithelium, which is responsible for the advancement of the fertilized egg to the uterus. The connective tissue begins to grow, a bubble is formed from it, where serous fluid accumulates - the hydrosalpinx itself.

Diagnosis: signs of left-sided and right-sided hydrosalpinx on ultrasound

Ultrasound diagnostics is the primary method of examination for suspected hydrosalpinx and obstruction of the fallopian tubes in general. Ultrasound clearly shows the presence of a tumor. If this is detected, further diagnostics are carried out to determine the nature of the formation and the degree of overlap of the lumen of the appendage. Such details are revealed by laparoscopic examination and a test for tube patency, for example, hydroturbation.

Progress of the examination:

• on the examination chair. The size of the ovaries and uterus is checked by touch. The doctor asks if the patient feels acute pain.
• Microflora smear.
• . The doctor examines the patient using an ultrasound diagnostic device with . An ultrasound detects a neoplasm, but its nature is not established.
• X-ray allows you to see the patency or obstruction of the appendages.
• Laparotomy recognizes the nature of the neoplasm and confirms whether it is hydrosalpinx or another disease.

What can be seen on an ultrasound

Ultrasound diagnostics can reveal the first signs of hydrosalpinx, but does not confirm the diagnosis 100%. Sometimes the neoplasm is confused with a serosocele - an accumulation of serous fluid in the appendages. In this case, ultrasound visualizes free fluid between the ovary and uterus, as well as dilation of the fallopian tubes. This is enough to detect the disease in its early stages.

Also, the ultrasound shows a follicular-shaped hydrosalpinx, the septa and the location of the capsules relative to each other are clearly visualized.

An ultrasound is performed between 5 and 9 days from the beginning of the last menstruation. You can undergo ultrasound diagnostics later, but the results will be preliminary. An accurate diagnosis is made after a comprehensive examination of the patient or after laparoscopy (insertion of a flexible endoscope with a camera and light at the end through a micro-incision).

U Ultrasonic waves can reveal hydrosalpinx or anechoicity, which is characterized by serous fluid inside the capsule. In this case, the doctor writes “sactosalpinx,” meaning the presence of a capsule inside the fallopian tube. X-ray examination is required to confirm the diagnosis.

Confirmatory methods prescribed after ultrasound

• Hysterosalpingography.An effective way to determine the form of the disease is hysterosalpingography. This is an X-ray using oily, water-soluble, contrast-colored substances injected into the fallopian tubes.
• Mmagnetic resonance imaging.MRI detects small areas of inflammation, adhesions or other pathology. The procedure makes it possible to display pathology in a section, including the location of the septa, the outline of the capsule and the parameters of the wall of the fallopian tube.

Treatment of hydrosalpinx

Having learned about the diagnosis, women wonder whether hydrosalpinx can be treated. Yes, it can be treated, and the sooner the patient seeks help, the greater her chances of maintaining reproductive health. Thematic forums are filled with reviews of women who successfully treated the disease and gave birth to healthy babies.

The disease requires complex treatment, including the simultaneous use of different methods. Hydrosalpinx is often treated surgically due to regular relapses during conservative treatment.

What is the most effective treatment for hydrosalpinx?

Treatment of the disease comes down to three complementary methods: conservative, surgical and physiotherapeutic.

Conservative treatment is the primary method.It comes down to eliminating inflammation in acute hydrosalpinx. But treatment with pills does not eliminate scars and adhesions, so drugs are prescribed when the cause of the disease is inflammation of the fallopian tubes and ovaries.

Conservative treatment includes antibiotic treatment and physical therapy. The pathogenic microflora is resistant to antibiotics, so the medicine is selected individually for the patient. If the patient has undergone antibiotic therapy before, autohemotherapeutic methods are prescribed that stimulate local immunity (infusion of her own blood, placenta, aloe vera extract). To reduce and soften adhesions, enzymes and bacterial polysaccharides (Prodigiosan, Pyrogenal) are prescribed.

In the chronic course of the disease, when adhesions and obstruction are pronounced, only surgical intervention will help.

• Salpingectomy. This is a radical way to eliminate the problem; the patient has the fallopian tube removed from one or both sides. Depending on the extent of the lesion, the operation is performed laparoscopically (through small punctures), endoscopically (using an endoscope through the vagina or an opening in the abdomen) or through an incision in the abdominal wall.
• Salpingo-ovariolysis.Adhesions are dissected using an endocoagulator in the lumen of the fallopian tube. Thanks to the temperature of 120 0 The method is gentle and bloodless. The blood vessels are instantly cauterized and stop bleeding.
• Salpingoneostomy.The procedure refers to reconstructive plastic surgery and includes a set of surgical procedures, such as fimbryoplasty (connection of the part of the tube that goes into the ovary), dilatation or diaglutination (unsticking) of the mouth of the tube, salpingostomy (creation of a new mouth of the fallopian tube). Tweezers or a mosquito is inserted into the appendage, which opens, expanding the lumen. Sometimes scars and adhesions are dissected, followed by sutures.
• Fibryolysis.The procedure is aimed at separating the glued fimbriae (villi that line the walls of the pipe from the inside). Through a hole in the wall of the appendage, a liquid dye is injected inside, which helps to identify areas of glued fimbriae. The adhesions are dissected with a coagulator, and the colored liquid passing under pressure using special forceps expands the lumen of the appendage and the fimbriae are unstuck.

How to treat hydrosalpinx if surgery is contraindicated and antibiotics are ineffective?

Physiotherapy will help in the treatment of left-sided and right-sided hydrosalpinx:

• Laser therapy. The site of hydrosalpinx is exposed to a laser light flux with a power of 5 to 100 W of specified energy parameters. As a result, metabolic processes improve and scar tissue softens. Hydrosalpinx on the left is found in gynecology more often than a right-sided neoplasm, the treatment of which is similar to how hydrosalpinx on the right is removed (treatment includes certain types of physiotherapy).
• Medicinal electrophoresis.A dose of electric current is applied to problem areas. Medicines penetrate faster and are better absorbed.
• Paraffin baths.Improves blood circulation, restores blood microcirculation in areas prone to adhesions.
• UHF therapy.Low-intensity ultraviolet rays inhibit bacteria, improve blood circulation, and accelerate recovery.

The procedures are painless for the patient and bring tangible results. After 2-3 procedures, women note a decrease in pain and a general improvement in well-being.

Complications and consequences.

Hydrosalpinx is a capsule in which serous fluid accumulates, resulting from the infiltration of lymph through the blood vessels. Serous fluid contains protein, leukocytes and other substances. When tissues adhere, circulatory disturbance occurs, and fluid accumulates in the cavities, forming transudate, which contains up to 2% protein and does not contain enzymes.

If changes in the tissues of the fallopian tube are caused by infection and inflammation, exudate accumulates instead of transudate. It contains more leukocytes and has a greater density than transudate. If a tube bursts due to hydrosalpinx, the consequences are such that the contents of the capsule will enter the fallopian tube, and from there into the vagina or abdominal cavity.

The danger is that if the capsule with serous contents ruptures, transudate will leak into the abdominal cavity. This threatens with peritonitis - acute inflammation of the peritoneum with the development of edema, poor circulation and toxic poisoning of the body.

If the disease does not make itself felt for a long time, the symptoms are not pronounced, the woman may not pay attention to health problems. As the hydrosalpinx increases in size, it causes inflammation and a subsequent dangerous consequence - an abscess. This is an inflammatory process accompanied by the release of pus and accumulation in the cavity (capsule).

Can a pipe burst with hydrosalpinx?

Hydrosalpinx by itself is not capable of tearing the appendage. However, there is a danger with the follicular form of the disease and some associated factors. These include:

• A new infection of the genitourinary organs, which leads to the revival of pathogenic microorganisms and inflammation of the wall of the appendage.
• . In this case, the gap will occur soon after fertilization.
• When the walls of the fallopian tube become thinner due to purulent inflammation.
• Too intense growth of follicular formation.

If the hydrosalpinx bursts, is this a sign of HIV?

A person infected with HIV has no immunity. The body is unable to resist infection. All life support systems suffer: genitourinary, cardiovascular, endocrine. A chronic disease becomes acute and cannot be treated.

It is not surprising that hydrosalpinx increases in size and worries the woman. It is possible that a weakened immune system will accelerate the growth of the tumor, which can burst and release transudate into the lumen of the appendage. But it is not correct to consider hydrosalpinx a direct sign of HIV, because rupture of the capsule also occurs in a woman without HIV.

Complications and consequences of hydrosalpinx

Like any pathology, hydrosalpinx has negative consequences for the patient’s health. Possible complications include:

• Bend of the uterus or change in the position of the uterus relative to the body (normally it should tilt forward), the cause of the bend is adhesions of the peritoneal organs, caused by infections or viruses.
• Violation of the vaginal microflora. Each neoplasm, even benign, disrupts the immune system, and therefore the natural microflora, increasing the number of opportunistic bacteria.
• Rupture of the fallopian tube (in advanced cases of the disease).
• Development of ectopic pregnancy. A capsule with serous fluid blocks the lumen of the epididymis, but does not cause rejection of the fertilized egg.
• Abscess. The accumulation of pus due to the spread of pathogenic bacteria in the capsule leads to organ dysfunction.
• Problems with the intestines, as the infection spreads to neighboring organs.
• Disruption of ovarian function, cycle failure (under conditions of inflammation, the egg stops producing oocytes).
• Infertility (even after treatment, only half of women are able to get pregnant on their own).

Hydrosalpinx and pregnancy

Hydrosalpinx is not a death sentence, despite the decrease in a woman’s ability to conceive.

Hydrosalpinx at the initial stages is small in size, so it does not interfere with the passage of the egg through the lumen of the tube. In addition, if inflammation is recognized in time and appropriate treatment is carried out, the adhesions soften, become elastic and sometimes resolve. A capsule that does not block the lumen will not be an obstacle to the egg or sperm.

Some patients suffering from follicular hydrosalpinx worry whether it is possible to become pregnant with hydrosalpinx of one tube. The likelihood of a productive outcome is high because one appendage is involved in fertilization, not both. If the egg goes through a healthy fallopian tube, with a favorable combination of factors (healthy sperm, a healthy egg, healthy condition of the uterus and endometrium), pregnancy occurs in 99%.

Those who became pregnant with hydrosalpinx note two factors that threaten pregnancy:

• Serous fluid, secreted by the mucous membrane of the fallopian tube and uterus and having a number of functions, with hydrosalpinx and adhesions accumulates in places where the tube is narrowed. If the adhesions are soft, the pressure of the water stretches the wall, and the serous fluid breaks into the uterus. If a zygote is encountered along the flow path, it will be washed away and the embryo will not attach to the uterine cavity.
• If, during ovulation, the egg is released into an unhealthy fallopian tube, there is a possibility of an ectopic pregnancy. In this case, the woman will have the affected tube removed along with the embryo.

Pregnancy after hydrosalpinx

Pathologies of the fallopian tubes in 25-30% of cases cause infertility. If a woman has undergone surgery to eliminate adhesions and remove hydrosalpinx, restorative procedures are carried out for 2 years to resume peristalsis and revive dormant microvilli (fimbriae).

After surgical removal of a small hydrosalpinx and small adhesions, pregnancy occurs in 77% of cases, and only under the condition that one tube was affected by the disease, and not both appendages. Ectopic pregnancy occurred in 2-3%.

F factors with a favorable prognosis for pregnancy after surgery:

• Unity of adhesions. Follicular adhesions lead to removal of the tube.
• Adhesion density. Filmy, elastic adhesions are easier to remove and have fewer consequences than rough and dense ones.
• The diameter of the hydrosalpinx capsule: sizes less than 15 mm are considered small, from 15 to 25 mm medium and over 25 mm large.
• The condition of the mucous surface of the fallopian tube. Folding leads to the death of fimbriae.
• Wall thickness. Thick fallopian tubes lack peristalsis and, accordingly, are immobile.

Conclusion:With favorable prognosis and a small size of the removed hydrosalpinx, there is a possibility of pregnancy occurring naturally.

Where to get diagnosed and treated for hydrosalpinx in St. Petersburg

Such an examination is carried out in St. Petersburg at the specialized gynecological clinic Diana. There is a new expert Doppler ultrasound machine here. The cost of a comprehensive pelvic ultrasound is only 1000 rubles. The cost of treating pathology depends on the form and stage of the process. With timely treatment, everything may be limited to an appointment with a gynecologist, the cost of which is 1000 rubles. and re-appointment after ultrasound and tests.

- hydrosalpinx. According to statistics, it is detected in 30% of women of reproductive age. Pathology interferes with the successful conception of a child. However, with adequate treatment, pregnancy is possible. In today’s article we will talk about how to recognize the disease in a timely manner, what methods of treatment modern medicine offers.

Structure and functions of the fallopian tubes

To understand the mechanism of development of the disease and its possible causes, it is necessary to delve into the anatomy. The uterine or fallopian tube is a paired organ with two lumens. Its length is 10-12 cm. One end of the tube opens into the uterus, and the other ends in villi and exits near the ovary. With the help of these openings, the abdominal cavity communicates with the genitals.

The walls of the fallopian tube consist of three layers: outer, muscular and inner. The first is represented by the peritoneum and performs a protective function. The muscle layer promotes contractile movements directed towards the uterine cavity. The inside of the fallopian tube is lined with ciliated epithelium. Its main function is to perform wave-like movements, thanks to which the fertilized egg freely enters the uterus. Between the elements of the ciliated epithelium are located. They are responsible for the production of a special secretion. This substance supports the viability of sperm, eggs and embryos in the initial stages of its development.

What is tubal hydrosalpinx?

This is a gynecological disease, which over time leads to disruption. It is characterized by the gradual accumulation of transudate in the lumen of the canals. As a result, the pipe turns into a formation that looks like a bag. At the initial stage of development, the pathological process practically does not manifest itself. Usually the disease is diagnosed when a woman consults a gynecologist in search of the causes of infertility.

Doctors distinguish the following forms of hydrosalpinx:

• left-handed;
• right-sided;
• double-sided

The unilateral form of the disease is characterized by the appearance of inflammation in only one tube. In this case, a woman can become pregnant on her own, but the probability of successful conception is halved. With bilateral hydrosalpinx, both tubes are blocked. It is impossible to become pregnant with such a diagnosis if you do not consult a doctor in a timely manner. Subsequently, complete infertility may develop, in which the probability of independently bearing and giving birth to a healthy child is zero.

Separately, it is necessary to consider the chronic form of the pathology. It develops gradually and does not manifest itself with any deviations. The woman feels great. Hydrosalpinx of the fallopian tubes is discovered accidentally during an examination by a gynecologist. Therefore, it is so important to periodically undergo preventive examinations with this doctor.

Mechanism of disease development

Malfunction of the fallopian tubes begins against the background of inflammation, for example with salpingitis or salpingoophoritis. Pathological growth of connective tissue occurs, numerous adhesions and scars are formed. Inflammation gradually spreads to all layers of the fallopian tubes.

The villi of the ciliated epithelium die, and the muscle layer ceases to fully contract. Adhesions grow in the lumen of the pipe, disrupting its patency. Secretion begins to accumulate in the formed cavity. It is produced by epithelial glands in response to existing inflammation. This is how a disease of the fallopian tubes develops - hydrosalpinx.

Main reasons

The occurrence of the disease is caused by the closure of the middle section of the fallopian tubes. Usually this problem is the body's response to a local inflammatory process. Infectious agents penetrate through both ascending and descending routes. In the first case, they mean the organs of the reproductive system (cervix, uterus, vagina). The second refers to the entry of infectious agents along with the blood flow from the appendix, kidneys or bladder. Sometimes inflammation is of an aseptic nature, when its development is preceded by various gynecological ailments.

Doctors identify the following causes of hydrosalpinx of the fallopian tubes:

• frequent abortions, diagnostic curettages of the uterine cavity;
• use of an intrauterine device;
• hypothermia (activation of pathogenic flora occurs against the background of weakened immunity);
• frequent change of sexual partners;
• inflammatory processes affecting the area of ​​the appendages and ovaries (oophoritis, adnexitis);
• adenomyosis;
• endometritis;
• vaginal dysbiosis.

A unilateral process (hydrosalpinx of the left fallopian tube or just the right one) often occurs due to anatomical disorders or as a result of pyosalpinx. In this case, the purulent contents are completely absorbed, leaving only the serous secretion. A bilateral pathological process affecting both fallopian tubes is formed against the background of chronic inflammation caused by various infectious agents.

Clinical picture

What are the symptoms of tubal hydrosalpinx? At the initial stage of development of the disease, there are no characteristic signs, since inflammatory processes are not active. It is detected, as we have already said, by chance, during an examination by a gynecologist.

As the disease progresses, an expanded clinical picture appears. Increased secretion of mucus by the epithelial glands leads to overfilling of the pipes, as a result of which they increase in size. Because of this, a woman has a feeling of heaviness in the lower abdomen. If the pathology is bilateral in nature, such a symptom appears on both sides. From time to time, it is possible to increase the temperature to subfebrile levels. In some cases, women note increased secretion from the vagina.

When diagnosed with “obstruction of the fallopian tubes,” hydrosalpinx affects the reproductive abilities of the body. When the lumens are completely closed, the egg cannot enter, so fertilization does not occur. This disorder is called If the lumen is not completely blocked, the folds of the mucous membrane are smoothed out, and the muscle tissue atrophies. As a result of these changes, a woman's risk of ectopic pregnancy increases.

An unpleasant complication of hydrosalpinx is a rupture of the fallopian tube. This disorder is characterized by the appearance of severe pain in the lower abdomen and tachycardia, and a decrease in blood pressure. The skin gradually turns pale, and clearly visible bubbles of sweat appear on it. If these symptoms occur, you should immediately call a team of medical professionals.

Hydrosalpinx and pregnancy

Laparoscopy is recommended for women with hydrosalpinx planning pregnancy. This procedure allows you to restore the patency of the pipes, but this often disrupts their natural function. In addition, the number of receptors for the main hormones - estradiol and progesterone - is sharply reduced. These factors can lead to ectopic pregnancy.

If the pathological process extends to only one tube, conception is possible. However, the presence of a focus of inflammation in the pelvis is detrimental to the developing embryo. The fluid it contains consists of lymphocytes and other toxic agents. Therefore, pregnancy without surgical treatment is not recommended. Removal of the fallopian tubes for hydrosalpinx does not reduce a woman’s sexual desire or affect her hormonal levels or menstrual cycle. With a bilateral form of the disease, natural pregnancy is impossible. In this case, the woman is recommended to undergo IVF.

Resection of the fallopian tubes before in vitro fertilization entails an increase in the likelihood of successful conception by approximately 30%. The prognosis is significantly improved if removal surgery is performed immediately, rather than trying to restore the patency of the oviducts using various options for laparoscopy.

Previously, it was suggested that removal of the fallopian tubes entails disruption of the blood supply and nervous regulation of the ovaries. Conducted studies have not confirmed this information. Removal of affected tubes before IVF does not affect the condition of the ovaries, their response to the stimulation process, or the fertilization rate.

Diagnostic methods

If you suspect hydrosalpinx of the fallopian tubes, you should immediately contact a gynecologist. Diagnosis of this disease begins with examination of the patient. When performing bimanual palpation, the pathology is palpated in the form of an elongated tight formation only on one or simultaneously on both sides. Painful discomfort may occur during this procedure. Then they move on to instrumental diagnostic methods. Among them, the most informative are the following procedures:

1. Transvaginal Ultrasound. Allows you to determine hydrosalpinx, establish location, shape and approximate size.
2. Hysterosalpingography. Helps assess the patency of the fallopian tubes. During diagnosis, a contrast agent is injected into the uterine cavity under pressure. After this, a series of x-rays are taken, in which the internal genital organs are clearly visible.

In medical practice, there are cases when, after such an examination, women became pregnant on their own. On the other hand, it increases the likelihood of exacerbation of chronic inflammation.

A more reliable diagnostic method is laparoscopy of fallopian tube hydrosalpinx. The use of this method allows you to assess their condition and take the contents to determine the infectious pathogen and its sensitivity to antibiotics. Sometimes doctors refrain from laparoscopy due to its invasiveness. Such an intervention can enhance the development of the adhesive process.

Based on the examination results, the doctor confirms or refutes the preliminary diagnosis and makes recommendations for treatment. Therapy for this pathology can be conservative or surgical. Let's consider each of the options in more detail.

Conservative treatment

Therapy should begin immediately after the doctor confirms the diagnosis of tubal hydrosalpinx. Treatment without surgery is recommended for women who are no longer planning a pregnancy, or for minor severity of the pathological process. Antibacterial drugs are prescribed to combat inflammation. The duration of the course of therapy and the dosage of medications is determined by the doctor. In this case, the specialist must take into account the sensitivity of the pathogenic flora to the drugs used and the nature of the pathogen.

Conservative treatment includes measures to stimulate the immune system. For this purpose, patients are prescribed immunomodulatory drugs (“Tactivin”, “Timalin”, “Imudon”) and vitamin complexes. Physiotherapeutic procedures are widely used. They do not completely cure the disease, but have a beneficial effect on the body. Among them are:

• UHF;
• Ural Federal District;
• magnetic cutter;
• electrophoresis;
• endovaginal vibration massage.

If doctors have diagnosed advanced hydrosalpinx of the fallopian tubes, treatment is only possible through surgery.

Surgical treatment

How to treat hydrosalpinx of the fallopian tubes? Today, laparoscopy is used as a fundamental method for the surgical elimination of pathology. This is the most effective and at the same time gentle method of treatment. There are several varieties of this procedure. The doctor chooses a specific treatment option taking into account the patient’s health and the condition of the fallopian tubes.

1. Tubectomy. During this operation, the doctor resects one or both tubes. Its help is resorted to when there are no other treatment options for the disease.
2. Salpingoneostomy. The procedure involves the formation of a new opening in the fallopian tube.
3. Fimbryolysis. Surgical manipulations are aimed at releasing the villi of the final section of the tube from adhesions and removing fluid.
4. Salpingo-ovariolysis. During the procedure, the doctor cuts through the adhesions in the lumen of the tube.

Is pregnancy possible after tubal laparoscopy? Hydrosalpinx is a very serious pathology, the long course of which necessarily affects a woman’s health. A successful operation does not guarantee a quick conception of a baby. If the doctor managed to save the tubes and restore their patency, the oviduct will not fully function. The cilia of the ciliated epithelium may lose their mobility, and the muscle layer often stops contracting. As a result, normal peristalsis is disrupted. Therefore, women after surgery are at risk of ectopic pregnancy. For such patients, fertilization through IVF is recommended.

Preventive actions

Hydrosalpinx of the fallopian tubes, the treatment of which is described just above, is a serious disease. However, its occurrence can be prevented if you follow the following recommendations:

1. It is necessary to promptly treat gynecological ailments. If pain, uncharacteristic discharge or other unpleasant symptoms appear, you should immediately contact a gynecologist.
2. It is important to observe basic rules of personal hygiene. Doctors recommend taking a shower twice a day. During menstruation, you should change your hygiene products as often as possible.
3. It is better to give up promiscuity and always use barrier contraception.
4. It is necessary to adhere to a healthy lifestyle and eliminate all bad habits.

Hydrosalpinx of the fallopian tubes, if left untreated, can cause serious complications. These include not only infertility. Even with successful conception of a baby, there is a possibility of miscarriage or spontaneous miscarriage.

Hydrosalpinx occurs after inflammation of the fallopian tubes. This pathology is both a consequence of inflammatory changes in the tubes and a source of further destructive changes in the organ. The result of such disorders is tubal infertility or ectopic pregnancy.

What is pathology

Translated from Latin, hydrosalpinx means “liquid in a pipe.” The fallopian tubes are connected at one end to the uterine cavity, and at the other end they communicate with the pelvic cavity. The inside of the tube is lined with villous epithelium, which secretes mucus. The basis of the organ is the muscular layer. The muscles of the tube normally have the ability to perform peristaltic movements, that is, they have a directed vector of contraction from the external opening to the uterine cavity. This is necessary for the movement of the fertilized egg from the surface of the ovary into the uterine cavity for further implantation and development of the fetus.

The villi of the tubal epithelium also participate in the advancement of the fertilized egg. When the mucous membrane of the fallopian tubes becomes inflamed (salpingitis, salpingoophoritis), the epithelium loses a large number of villi. The muscular layer itself also undergoes structural changes due to the inflammatory process. The tube becomes deformed, and multiple adhesions appear in its cavity - strong fibrin threads that can completely block the lumen of the tube.

If fibrin deposits (adhesions) form at both ends of the fallopian tube, then gradually the organ will be filled with secretion, which the epithelial (inner) lining continues to produce. The pipe stretches and increases in volume. This is how hydrosalpinx or sactosalpinx is formed.

Types of inflammation of the fallopian tube

Depending on the localization of the primary inflammatory process, salpingitis or salpingoophoritis, there are:

• right-sided;
• left-handed;
• bilateral hydrosalpinx.

Depending on the internal structure of the cavity with liquid, they are distinguished:

1. Simple hydrosalpinx, when a single cavity with fluid forms inside the tube
2. Follicular, when the tube space is made in the form of cavities or follicles containing the secretion of villous epithelium.

Sometimes adhesions at one end of the fallopian tube have a loose structure. In this case, during physical exertion or a sudden change in body position, the fluid breaks into one of the ends and pours out - into the pelvis or into the uterine cavity. This type of pathology is called ventilated hydrosalpinx.

Liquid pouring into the pelvic cavity causes the formation of adhesions in the pelvis.

Fibrin deposits, or adhesions, are a natural reaction of the serous membrane (peritoneum) of the pelvic cavity to exposure to foreign fluids. Adhesions limit the mobility of the appendages and cause tubal infertility, or ectopic pregnancy.

One of the serious complications is suppuration, or pyosalpinx. This occurs due to the penetration of microbes into the cavity of the tube containing mucous secretion. In this case, a tube abscess forms - a pathology requiring surgical intervention.

The inflammatory process supports itself: structural changes in the epithelium and muscle walls are a direct consequence of salpingitis, and the cavity with fluid can fester at any time and cause further development of inflammation.

Development factors

The immediate cause of the development of hydrosalpinx is infection, pathogenic microorganisms that penetrate the tube cavity through the uterus (ascending path) or through the bloodstream from other foci (hematogenous). By affecting the mucous membrane, microorganisms cause swelling, disturbances in blood microcirculation, stagnation of fluid and sweating of exudate into the lumen of the tube.

In response to these changes, the fallopian tube loses its elasticity, its motility is impaired, and the epithelium loses its villous structure. Fibrin begins to be deposited in the lumen of the tube, adhesions form and the outlet openings of the organ close.

In addition to the inflammatory process, pathology is formed as a result of:

• endometriosis;
• pelvic tumors;
• adhesive process after operations.

Factors contributing to the formation of fluid in the fallopian tube:

• sexual infections;
• abortions;
• diagnostic curettage;
• hysteroscopy;
• installation of the spiral.

Reasons for development - video

Symptoms and signs

Since the pathology is formed after the inflammatory process, often obvious signs of the disease are not detected. Hydrosalpinx can be asymptomatic and discovered by chance on an ultrasound.

In other cases, women complain:

1. Periodic nagging or cramping pain in the right or left lower abdomen.
2. For periodic heavy discharge from the genital tract. This symptom is especially characteristic of ventilated hydrosalpinx, when the fallopian tube is emptied after physical exertion, its contents enter the uterine cavity and then into the vagina.
3. Infertility, that is, prolonged unsuccessful attempts to get pregnant.

Diagnostics

To make a diagnosis, it is necessary to collect an anamnesis - diseases and conditions preceding the pathology. The following features are taken into account:

1. Features of the appearance of pain in the lower abdomen - against the background of temperature and general malaise, which indicates previous inflammation of the appendages.
2. The nature of the discharge - the appearance of sudden copious discharge from the vagina most often indicates emptying of the fallopian tube.
3. Conditions after which symptoms appeared. As a rule, women with this pathology have previously had abortions, intrauterine manipulations, or sexually transmitted infections.

After collecting anamnesis, an examination is carried out:

1. A gynecological examination, which in some cases allows you to identify an enlarged tube as a formation between the uterus and ovary. In the case of adhesions, the enlarged tube is limited in mobility, its palpation is moderately painful.
2. Ultrasound examination of the pelvic organs, mainly using a vaginal probe. Liquid in the pipes is defined as an anechoic (not reflecting ultrasonic signal) formation.
3. Microscopic examination of a smear from the vagina, cervix and urethra for microflora.
4. PCR diagnostics, or detection of pathogen fragments using polymerase chain reaction.
5. Bacterial culture of secretions to determine the sensitivity of microflora to antibiotics.
6. Salpingography is an x-ray examination after the introduction of a contrast agent into the uterine cavity. The image shows an enlarged tube filled with a contrast agent. In case of partial patency of the tube, the contrast agent flows into the pelvic cavity.
7. Diagnostic laparoscopy, or visual examination of the appendages using a special instrument - a portable video camera, which is inserted directly into the pelvic cavity. The fallopian tube is dilated and filled with contents.

Differential diagnosis is carried out:

• with an ectopic (tubal) pregnancy;
• with ovarian retention cysts;
• tubal endometriosis.

How to distinguish hydrosalpinx from other diseases

Treatment: surgery, laparoscopy and other methods

When determining treatment tactics for this pathology, the following principles are used:

1. The patient's age and her plans for pregnancy. If a woman is young, under 35 years old, and is planning a pregnancy, then the main goal of treatment is to restore the patency of the fallopian tubes.
2. If the woman’s age does not allow for future pregnancy, then the main tasks are to eliminate adhesions in the pelvis, inflammatory processes and reduce the risk of purulent complications (pyosalpinx).
3. It is almost impossible to cure the pathology using conservative methods alone. Drug treatment and physical therapy are used only as a preparatory stage for surgical intervention. The exception is women with minor changes in the fallopian tubes who are not planning a pregnancy or refuse surgery for other reasons.

At the first stage:

1. Antibiotic therapy taking into account the sensitivity of the microflora. Cephalosporins (Cefazolin and Cefotaxime), macrolides (Clarithromycin) and fluoroquinolones (Levofloxacin, Azithromycin and Clarithromycin) are used. Medicines and dosages are prescribed by the attending physician.
2. Treatment with non-steroidal anti-inflammatory drugs (Voltaren, Diklak, Ortofen).
3. Treatment with immune stimulants (Interferon and its inducers - Methylglucamine acridone acetate and others).
4. Vitamin therapy - vitamins of groups B, C and E.

It is important to remember that application may cause the growth of fungal flora that causes intestinal and vaginal infections. Therefore, it is necessary to take antifungal drugs as prophylaxis: Clotrimazole, Fluconazole and Polygynax.

The drug Longidaza is of particular importance in the treatment of adhesions in the pelvis. This is an enzyme preparation that has proteolytic activity, that is, the ability to resolve fibrous adhesive structures - the main reason for the formation of the disease. The drug is administered intramuscularly; the dosage and course of treatment are prescribed by the attending physician.

Previous methods, such as vaginal tampons with ichthyol ointment, Vishnevsky or Levamekol, are less effective.

Drugs for the treatment of pathology

Cephalosporin for the treatment of pathology Combination drug Enzyme for resorption of adhesions Macrolide for complex therapy

To relieve the inflammatory process and prevent further formation of adhesions, physiotherapy is used as additional methods:

1. UFO blood - for the purpose of detoxification and activation of the immune system
2. Electrophoresis of magnesium and potassium ions
3. Exposure to UHF (ultra-high frequency currents), which have a pronounced anti-inflammatory effect
4. Exposure to the Darsonval apparatus, which provides an increased flow of oxygen to inflamed tissues, activates local immunity, and also has analgesic and bactericidal effects
5. Magnetophoresis, or exposure to an electromagnetic field. This is expressed in reducing tissue swelling and improving microcirculation, which speeds up the process of relieving inflammation.
6. Hirudotherapy, or placement of leeches. They collect part of the “damaged” lymph, which helps eliminate tissue edema and restore microblood flow. In addition, leeches inject their enzymes into the blood, which have a bactericidal and absorbable effect.
7. Massage of the affected appendage area is performed by a gynecologist. Massage helps to empty the contents of the tube in case of patency of the uterine opening.

After the elimination of the inflammatory process, the second stage begins - surgical restoration of the patency of the fallopian tubes. To do this, a laparoscopic technique is used:

• separate the adhesions that fix the tube to the pelvic organs;
• empty the contents of the pipe;
• restore its integrity and patency.

All these actions are possible with small pathologies, with preserved folding of the tube and without pronounced degenerative changes in the organ. In other cases, the affected organ is removed.

In cases of pronounced dystrophic changes in the fallopian tubes on both sides, after bilateral organ removal, pregnancy is possible only through IVF (in vitro fertilization).

During treatment, women must observe some restrictions:

1. Avoid sports activities that involve sudden changes in body position.
2. Avoid intense sexual intercourse.
3. Limit exposure to open sun and solariums, and avoid overheating (hot baths and saunas).
4. Follow a diet: limit spicy foods and completely eliminate alcohol.

Prognosis and complications

Long-term hydrosalpinx can be complicated by:

1. Violation of the integrity of the tube with spillage of contents into the pelvic cavity. As a rule, this is possible with excessive physical exertion.
2. Suppuration - the formation of pyosalpinx, a chronic purulent abscess of the tube.
3. Persistent dysfunction of the fallopian tubes.

If you consult a doctor in a timely manner, you can minimize the risk of complications.

With adequate treatment and restoration of tubal patency, spontaneous pregnancies are possible. If the degenerative processes in both fallopian tubes were irreversible, which led to the removal of organs, then pregnancy is only possible with the help of IVF.

What is Hydrosalpinx? This question arises for almost all women who have been given such a tricky diagnosis. If we leave complex medical terms aside, then we can say otherwise that this is dropsy of the fallopian tube (oviduct). Yes, yes, a bag of liquid has formed on the pipe, the dimensions of which vary widely.

Sometimes, after removing a pathological formation, a woman is shown just a huge “bubble” with a cloudy liquid, reaching the size of a small children’s ball. The female reproductive system is a fairly complex and precise structure, which in its normal state provides ideal conditions for conceiving a new life.

It is no coincidence that oviducts got their name. They are the real path along which the egg or zygote (newly born fetus) “goes” into the uterine cavity. What if this path suddenly became impassable? Then pregnancy becomes impossible, and the woman’s doctors are forced to make a terrible diagnosis - Infertility. When making this diagnosis, the ICD code 10 - N70.1 is prescribed in the medical history.

Chronic hydrosalpinx

Chronic hydrosalpinx on the left or right is an already advanced stage of the disease. It is characterized by a “blurred” clinical picture, it proceeds almost unnoticed, causing irreparable harm to the woman’s reproductive system. The constant presence of inflammation and exudate disrupts the functioning of the fallopian tubes. They lose their contractility and elasticity.

But the biggest pathological changes concern the ciliated layer of the oviduct. Cilia, small projections on the lining of the reproductive organ, are designed to help a fertilized egg reach the uterus. They seem to roll over the zygote, because it is deprived of organs of movement. But when dropsy occurs, the eyelashes stick together, and therefore their natural function is disrupted.

Bilateral hydrosalpinx is becoming more common these days. This diagnosis indicates that the oviducts are affected on both sides (Hydrosalpinx on the right, on the left). Bilateral damage to the reproductive system sharply worsens treatment prognoses and increases the risk of infertility. According to statistics, right-sided and left-sided lesions of the fallopian tubes occur with the same frequency.

What is valve hydrosalpinx

It happens that the commissure blocks the oviduct, but the connective tissue has a softer, more pliable consistency. As liquid accumulates in the pipe, the pressure inside the cavity increases many times, which leads to overstretching of the walls.

The fluid begins to put pressure on the connective tissue with such force that the adhesion cannot withstand, and it becomes possible for the outflow of exudate, which breaks either into the uterine cavity or into the abdominal cavity.

Everything described above occurs with valve hydrosalpinx! The fallopian tube becomes partially patent, which in many cases helps a woman become pregnant. Hundreds of cases have been documented in which women became mothers even with enormous amounts of dropsy.

But a fluid breakthrough can also cause irreparable harm, especially when using IVF (in vitro fertilization). An embryo conceived outside a woman's body and then transferred to her uterus can simply be washed away by the flow of exudate. Thus, all the efforts of reproductive specialists (artificial insemination doctors) fail. That is why it is increasingly recommended to surgically remove dropsy of the fallopian tube before conception “in vitro”.

Causes of Hydroalpinx

The mechanism of occurrence of the disease has not been fully studied, but the causes of Hydrosalpinx include:

• congenital abnormal development of the organs of the reproductive system;
• disruption of the movement of lymph along the lymphatic tract;
• abdominal operations;
• previous ectopic pregnancy;
• pathological growth of the endometrium;
• perforated appendicitis;
• adhesive disease in the pelvic area;
• poor circulation and/or chronic foci of inflammation in the reproductive organs;
• previously suffered sexually transmitted diseases, especially Chlamydia and Gonorrhea;
• some intestinal pathologies.

The causes of bilateral Hydrosalpinx are identical to the above points.

Symptoms of Hydrosalpinx

The symptoms of Hydrosalpinx are very varied. These include:

• watery vaginal discharge. They may have a cloudy or serous-purulent structure;
• nagging pain in the area of ​​projection of the appendages. Their intensity is medium;
• When the disease worsens, women note a fairly sharp rise in temperature to 39 degrees. Celsius.

Much less common are prolonged rise in temperature, unexplained weakness, fatigue, poor general health, and depressive psychological conditions that are difficult to treat. These signs are identical for both Hydrosalpinx on the right and on the left.

All signs of Hydrosalpinx can appear with varying degrees of intensity, which increases the risk of incorrect or delayed diagnosis. Sometimes the woman herself delays the gynecological consultation, only aggravating her situation.

Why is the disease dangerous?

Consequences of Hydrosalpings:

• primary or secondary infertility;
• ectopic pregnancy;
• rupture (perforation) of the oviduct with internal bleeding;
• addition of infection and suppuration of exudate.

Differential diagnosis

Today, various methods for differential diagnosis of the disease are available. These include:

• Ultrasound (ultrasound examination). Hydrosalpinx on ultrasound looks like a liquid pathological inclusion, localized in the space between the ovary and the uterus itself. This echo sign is a decisive factor in making this diagnosis;
• gynecological examination;
• hysterosalpingography (hydrosalpingography (HSG);
• laparoscopy. It should be noted that laparoscopy can not only identify hydrosalpinx, but also cure it.

Conservative treatment

Treatment without surgery is the first step towards getting rid of the disease. To combat the inflammatory process, treatment with broad-spectrum antibiotics is used. Such drugs are prescribed not only in injections, but also in tablets and suppositories, which only simplifies treatment. Longidaza must be prescribed as a drug ideal for treating this disease.

To mobilize the body's own strength, general strengthening, vitamin, absorbable preparations and medications that remove excess fluid from tissues are additionally prescribed. The effect of drugs is enhanced by physiotherapeutic procedures and laser therapy.

Treatment of Hydrosalpinx: auxiliary methods

Sanatorium-resort treatment is especially indicated for women with chronic bilateral hydrosalpinx. Mud baths have a powerful absorbing effect, which will certainly be beneficial for this disease. After all, if the fallopian tubes restore patency, then the likelihood of pregnancy will increase many times over.

Homeopathy is another auxiliary method of treating the disease. The benefits of taking homeopathic medicines are very controversial, have no evidence base and are not accepted by official medicine. But, after a detailed consultation with a specialist, you can try this method of defeating the disease.

On the forms of those women who have cured the disease, one can increasingly see positive reviews about treatment with leeches. Even wise Chinese healers for thousands of years saved women from diseases of the reproductive system through the use of a special type of leeches. Then this technique was undeservedly forgotten, but today it is experiencing a real “boom” in popularity.

This pathology has long been treated with propolis. To prepare the tincture, use only high-quality raw materials or buy a ready-made product at the pharmacy. For home preparation, take medical alcohol (60%) and mix it with crushed propolis (40%). Use the tincture to rub the skin of the abdomen on the affected side.

In folk medicine, decoctions of anti-inflammatory herbs are used as medicinal microenemas. Juice treatment, which is combined with clay therapy, is actively used.

It should be remembered that traditional medicine cannot become the main treatment even if a mild degree of this pathology is detected. Folk remedies are just an addition to complex treatment!

Treatment of hydrosalpinx disease with surgery

Sometimes it happens that treatment of Hydrosalpinx can only be continued through surgery - removal of the dropsy. When removing Hydrosalpinx, a gentle technique is most often used - laparoscopy.

To carry it out, the latest optical technology is required, through which dropsy is removed without opening the abdominal cavity, which minimizes the risk of postoperative complications, reduces the likelihood of developing adhesions and bleeding, and does not cause serious cosmetic defects.

After the stage of removing the dropsy, the surgeon performs plastic surgery of the oviduct, restores its patency, excises adhesive scars and restores re. Laparoscopy of Hydrosalpinx has a number of contraindications, which the gynecologist treating you will definitely warn you about.

Some women suffer from a real phobia that prevents them from having surgery on time and finding the joy of motherhood. In such cases, a competent gynecologist will definitely advise you to visit thematic forums where you can casually communicate with people who have overcome identical problems.

On such sites you can look at photos and listen to videos about the stages of surgery, get acquainted with the symptoms and duration of the postoperative period, and find out the norm of laboratory tests. But if fear remains an insurmountable obstacle, then, without hesitation, you should go to a professional psychologist.

Conclusion

As you can see, Hydrosalpinsk is a very serious illness, therefore disease prevention should be dealt with immediately after the birth of a girl. It is the responsibility of parents to teach a girl or teenager to take care of their health. The child must understand the importance of reproductive health, so do your best to convey useful information to him. The woman comes from childhood. And if childhood and adolescence are passed in compliance with all the rules for preventing the disease, then the risk of developing pathology in adulthood is reduced significantly.

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