Hydrosalpinx

HYDROSALPINX (from Greek hydor-water and salpinx-tube), sactosalpinx serosa, hydrops of the tube, accumulation of fluid in the Fallopian tube. One of the main conditions for the formation of H. is the closure of the abdominal opening of the tubes, which most often occurs as a result of their catarrhal inflammation on the basis of infection. The most favorable moments for the introduction of infection are: menstruation, puerperium, intrauterine manipulations (sounding, dilation, curettage, washing of the uterus and insertion of pessaries). Sometimes the closure of the tube occurs from perisalpingitis, after spontaneous peritonitis, as a consequence of appendicitis and even without bacterial infection (e.g., in tumors and in various inflammatory changes in the pelvis). Cases of congenital imperforation of the tubes (Slavyansky) have been described, as well as H. in bends or closure of the lumen of a completely healthy tube by false membranes. In catarrhal salpingitis, the inflamed folds of the mucous membrane swell, stick together, causing closure of the tube lumen. The fimbriae on the free edge of the tube turn inward, sometimes giving a characteristic rosette appearance. The accumulating fluid stretches the ampullar, more pliable part of the tube, flattens the folds, and elongates the entire tube, which takes a club-shaped form. H. is most often bilateral. Uncomplicated H. is always mobile and located on the sides of the angles of the uterus. They may form adhesions with neighboring organs and become completely fixed. The size of H. varies: from the thickness of a pencil to the size of a child's head and larger. - The contents of H. - a transparent liquid, often yellowish, slightly cloudy, sometimes with an admixture of blood, containing protein, mucus, single leukocytes, desquamated epithelial cells, detritus. The reaction is neutral or slightly alkaline; specific gravity 1.010-1.022. - A rare phenomenon in H. - calcium deposits and intestinal parasites. Mako (Maso) describes the presence of pinworms (more likely - entered the tube through the genital canal). The contents of hydrosalpinx is usually completely sterile, although its occurrence in the vast majority of cases is the result of infection, most often gonorrheal. In addition to the inflammatory exudate and transudate formed as a result of stagnant phenomena, the normal secretion of the tube's mucous membrane may also accumulate. Experiments on animals showed that by tying the abdominal part of the tube, H. can be obtained with accumulation of the mucous membrane secretion, and histological examination of the tube's mucosa showed the presence of a large number of special secretory cells, without cilia, with a pear-shaped protrusion into the tube lumen. Changes in the walls of the tubes in H. depend mainly on their stretching. With weak stretching, the changes are insignificant, and they concern only the mucosa, where traces of inflammatory infiltration (small-cell with an admixture of plasma cells) can be found. The epithium in places may remain even with cilia. With strong stretching, the tube wall may become as thin as paper; in such cases, the muscular layer completely atrophies, the folds of the mucosa are smoothed out, and the inner surface becomes as smooth as the peritoneal surface. At this point, it is already impossible to find any traces of former inflammation; only in the ampullar end, at the place of fused fimbriae, foci of connective tissue formed at the site of inflammatory infiltration may sometimes remain. - The course of H. is usually long. In some cases, even regardless of size, H. can proceed completely hidden and unnoticed. With bilateral disease, the usual symptom is infertility. Sometimes the fluid flows out through the uterus to the outside, the tumor decreases in size and then fills up again (hydrops tubae profluens). At the beginning of the disease, cramp-like, colicky pains appear in the deep lateral parts of the abdomen due to contractions of the tubes. These pains are often mistaken for intestinal colic. General phenomena, such as increased temperature, increased pulse, may be completely absent or give only slight increases at the beginning of the disease. Menstruations, due to inflammatory and stagnant phenomena in the pelvis, may intensify and become painful. With accompanying perimetritic phenomena, painful sensations intensify and should be attributed to irritation of the peritoneum. - For diagnosis, in addition to the history, the main thing is the finding on the side of the uterus of an elastic tumor with a characteristic curved shape of the tube. Thin-walled, large H. can easily be mistaken for an ovarian cyst. - For treatment, it is very important to carry out differential diagnosis between H. and pyosalpinx. One should assume purulent contents of the tube with a sharply expressed leukocytosis (above 15,000), rapid sedimentation of erythrocytes (SR by Fareus) and repeated exacerbation of general phenomena (t^c, pulse, pain). Treatment is symptomatic. At the beginning of the process - rest, compresses, narcotics; in chronic form - all kinds of anti-inflammatory agents: light, baths, muds, diathermy, X-ray therapy, tampons. Often H. ends with complete recovery, and in some cases even with restoration of the physiological function of the tube. Thus, Kesteren out of 57 women who had H., observed pregnancy in 7. Nevertheless, in the vast majority of cases, damage to both tubes leads to persistent infertility, requiring radical surgical treatment: excision of the tubes, resection with suturing into the uterus of a healthy remainder and salpingostomy.