Haematosalpinx

HAEMATOSALPINX, an accumulation of blood in the Fallopian tube. According to generally accepted terminology, this does not include cases of blood accumulation during tubal pregnancy (see Pregnancy, ectopic pregnancy). By etiology, haematosalpinx can be subdivided into three groups: 1) those arising on the basis of atresia of the genital tract (see Gynaetresia), 2) those on the basis of torsion of the tube, and 3) those on the basis of inflammation of the tube and as a result of other, rarer etiological factors. Haematosalpinx of the first group does not arise independently, but is associated with haematocolpos and haematometra (see); in this case, haematosalpinx arises more frequently the higher up the genital tract the atresia is located. In the presence of vaginal atresia, menstrual blood, having filled the vagina and then the uterus, begins to accumulate in the tubes. In rarer cases of gynaetresia, haematosalpinx can form in the presence of congenital obstruction of the uterine end of the tube, such that in these cases the blood originates from the walls of the tube (possibly due to "torsion" of the tubes with subsequent hemorrhages). Usually, after the entry of blood from the uterus into the tube, its abdominal end quickly seals, and the blood begins to distend the walls of the tube; a tumor is formed—nodular, tortuous, and capable of reaching quite large sizes (regarding the character of the blood contained in the tumor, see Haematometra). In the clinical picture of haematosalpinx arising on the basis of gynaetresia, the symptoms of the latter dominate; the recognition of haematosalpinx, which is extremely important for the choice of therapy, appears quite difficult. As for the course of the disease, due to the thinning of the tube walls, its rupture may occur with subsequent fatal internal hemorrhage or peritonitis. Such an outcome most often occurs after an internal examination or with incorrect therapy, when in cases of haematosalpinx, operative assistance consisted only of the discission of the atresia, without removal of the tubes per laparotomiam, which can lead, upon rapid emptying of the vagina and uterus, to rupture of the tube or to subsequent suppuration of the contents of the haematosalpinx. Therefore, therapy for gynaetresia, upon any suspicion of haematosalpinx, should begin with the removal of the tubes via laparotomy. The second group of haematosalpinx consists of cases of torsion of the tube, whereby the latter may be either healthy or inflamed and altered. Torsion of already inflamed and altered tubes is observed more frequently (a little more than 100 cases have been published). With healthy tubes, torsion usually occurs in the presence of infantilism, with significant length and tortuosity of the tubes, and with sharp, strong movements of the torso, more often in young and pregnant women. As a result of the torsion, hemorrhage occurs into the lumen of the tube, with subsequent closure of the abdominal end and the formation of a tumor up to the size of an apple. When twisting inflamed and altered tubes (most often hydrosalpinx), a necessary condition is the absence of dense, extensive adhesions with surrounding tissues at the end of the tube. After torsion, the contents of the tube become bloody, and in the walls, one finds sharp venous hyperemia, hemorrhages, thrombosis of vessels, and tissue edema. The clinical picture of haematosalpinx arising as a result of torsion of the tube is completely identical to that of torsion of ovarian tumors, i.e., it develops acutely and requires rapid surgical intervention. In cases of torsion of the right tube, the operation was often undertaken under the mistaken diagnosis of appendicitis. The last group of haematosalpinx consists of cases arising during inflammatory processes in the tubes, whereby the inflammatory-hyperemic vessels rupture, and blood pours into the lumen of the tube. Finally, the formation of haematosalpinx is observed during severe infectious diseases (typhus, cholera), phosphorus poisoning, and heart defects—apoplexia of the tube similar to an analogous phenomenon in the uterus.