Hydrosalpinx
From
Wikipedia, the free encyclopedia
A
fallopian tube filled with blood is a hematosalpinx,
and with pus a pyosalpinx.
Hydrosalpinx
is a composite of
the Greek words ὕδωρ (hydro - "water") and σαλπιγξ (salpinx - '
"trumpet"); its plural is hydrosalpinges.
Contents
Etiology
The
major cause for distal tubal occlusion is pelvic inflammatory disease (PID), usually as a consequence of an
ascending infection by chlamydia or gonorrhea.
However, not all pelvic infections will cause distal tubal occlusion. Tubal tuberculosis is an uncommon cause of hydrosalpinx
formation.
While
the ciliae of the inner lining (endosalpinx) of
the fallopian tube beat towards the uterus, tubal fluid is normally discharged
via the fimbriated end into the peritoneal cavity from where it is cleared. If
the fimbriated end of the tube becomes agglutinated, the resulting obstruction
does not allow the tubal fluid to pass; it accumulates and reverts its flow
downstream, into the uterus, or production is curtailed by damage to the
endosalpinx. This tube then is unable to participate in the reproductive
process: sperm cannot pass, the egg is not picked up, and fertilization does not take place.
Other
causes of distal tubal occlusion include adhesion formation from surgery, endometriosis,
and cancer of the tube, ovary or other surrounding organs.
A hematosalpinx is
most commonly associated with an ectopic
pregnancy. A pyosalpinx is typically seen in a more acute
stage of PID and may be part of a tuboovarianabscess (TOA).
Tubal phimosis refers to a situation where the tubal end is partially occluded, in this
case fertility is impeded, and the risk of an ectopic pregnancy is increased.
Symptoms
Symptoms
can vary. Some patients have lower often recurring abdominal pain or pelvic pain,
while others may be asymptomatic. As tubal function is impeded, infertility is a common symptom. Patients who are
not trying to get pregnant and have no pain, may go undetected.
IUDs,
endometriosis, and abdominal surgery sometimes are associated with the problem.
As a reaction to injury, the body rushes inflammatory cells into the area, and
inflammation and later healing result in loss of the fimbria and closure of the
tube. These infections usually affect both fallopian tubes, and although a
hydrosalpinx can be one-sided, the other tube on the opposite side is often
abnormal. By the time it is detected, the tubal fluid usually is sterile, and
does not contain an active infection.
Diagnosis
Hydrosalpinx
may be diagnosed using ultrasonography as the fluid filled elongated and
distended tubes display their typical echolucent pattern. However, a small
hydrosalpinx may be missed by sonography. During an infertility work-up a hysterosalpingogram (HSG), an X-ray procedure that uses a contrast
agent to image the fallopian
tubes, shows the retort-like shape of the distended tubes and the absence of
spillage of the dye into the peritoneum. If, however, there is a tubal
occlusion at the utero-tubal junction, a hydrosalpinx may go undetected. When a
hydrosalpinx is detected by an HSG it is prudent to administer antibiotics to reduce the risk of reactivation of
an inflammatory process.
When
a laparoscopy is performed, the surgeon will note
the distended tubes, identify the occlusion, and may also find associated
adhesions affecting the pelvic organs. A laparoscopy not only allows for the
diagnosis of hydrosalpinx, but also presents a platform for intervention (see
management).
Prevention
As pelvic inflammatory disease is the major cause of hydrosalpinx
formation, steps to reduce sexually transmitted disease will reduce incidence of hydrosalpinx.
Also, as hydrosalpinx is a sequel to a pelvic infection, adequate and early antibiotic treatment of a pelvic infection is
called for.
Management
For
most of the past century patients with tubal infertility due to hydrosalpinx
underwent tubal
corrective surgery to open up
the distally occluded end of the tubes (salpingostomy) and remove adhesions
(adhesiolysis). Unfortunately, pregnancy rates tended to be low as the
infection process often had permanently damaged the tubes, and in many cases
hydrosalpinges and adhesions formed again. Further, ectopic
pregnancy is a typical
complication.Surgical interventions can be done by laparotomy
or laparoscopy.
Non-infertile
patients who suffer from severe chronic pain due to hydrosalpinx formation that
is not relieved by pain management may consider surgical removal of the
affected tube(s) (salpingectomy) or even a hysterectomy with removal of the tubes, possibly
ovaries.
IVF and
hydrosalpinx
With
the advent of IVF which bypasses the need for tubal
function a more successful treatment approach has become available for women
who want to conceive. IVF has now become the major treatment for women with
hydrosalpinx to achieve a pregnancy.
Several
studies have shown that IVF patients with untreated hydrosalpinx have lower
conception rates than controls and it has been speculated that the tubal fluid
that enters the endometrial cavity alters the local environment or affects the embryo in a detrimental way. Thus, many
specialists advocate that prior to an IVF attempt, the hydrosalpinx should be
removed.
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