Adnexitis

Types of adnexitis

The reasons

Symptoms of adnexitis

Diagnostics

Adnexitis treatment

Complications and prognosis

Adnexitis is an inflammation of the appendages of the uterus, which include the fallopian tubes and ovaries.

Translated from Latin, salpinx means the fallopian tube, and ovarium means the ovary; therefore, another name for adnexitis is salpingoophoritis.

Adnexitis, as a rule, women of reproductive age (20-35 years) are ill.

Types of adnexitis

Acute, subacute and chronic adnexitis are distinguished by the nature of the course.

Depending on the involvement in the pathological process of appendages on both or on one side, adnexitis can be one-sided or two-sided.

For the reason that led to the occurrence of the disease, distinguish between non-specific and specific (for example, gonorrheal) adnexitis.

The reasons

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The cause of the development of adnexitis are pathogenic microorganisms.

Specific adnexitis is caused by gonococci, tubercle bacillus, and pathogens of diphtheria.

Nonspecific adnexitis develops when streptococci, staphylococci, Escherichia coli, mycoplasma, and other bacteria penetrate the uterine appendages.  

The infection can spread in an ascending way in case of inflammation of the vagina, cervix or uterus, and in a descending way from other organs located above (for example, appendicitis).

Predisposing factors for adnexitis include:

  • weakening of immunity;
  • hypothermia;
  • stress;
  • frequent and indiscriminate change of sexual partners;
  • unprotected sex during menstruation;
  • non-compliance with personal hygiene;
  • transferred infectious disease;
  • chronic common, including endocrine, diseases;
  • abortion and diagnostic curettage of the uterus;
  • intrauterine device;
  • uterus hysteroscopy and metrosalpingography. 

Symptoms of adnexitis

Manifestations of the disease depend on its course.

Signs of acute form

Acute adnexitis and exacerbation of chronic adnexitis is characterized by

  • a sharp increase in body temperature to 38 – 39 degrees,
  • signs of intoxication (nausea, vomiting, weakness, lack of appetite),
  • pain in lower abdomen.

Pain in acute adnexitis are cutting, can give the lower back and rectum.

Perhaps the addition of symptoms of urination disorders (pain during urination, increased frequency).

On palpation there is a sharp pain and tension of the abdominal muscles.

In advanced cases, signs of peritoneal irritation may appear ( Shchetkin-Blumberg sign ), which indicates peritonitis. 

In severe cases, purulent fusion of the uterine appendages ( tubo-ovarian formation) develops, which requires urgent surgical intervention.

In case of late or inadequate treatment, acute adnexitis becomes chronic.

Symptoms of the chronic form

Chronic adnexitis is characterized by periodic aching or pulling pains in the abdomen and lower back, which radiate to the vagina, rectum and lower extremity.

A characteristic symptom of a chronic process is dyspareunia (pain during intercourse).

In addition, due to the formation of adhesions in the pelvic area and changes in ovarian function, menstrual irregularities of the oligomenorrhea type (rare and scanty periods) and amenorrhea (absence of menstruation for 6 months or more) develop.    

Also, with chronic adnexitis, menses become painful. Pain in the chronic course of the disease is aggravated after hypothermia, stressful situations, before the onset of menstruation.

During a vaginal examination, in case of acute or acute adnexitis in the region of the uterus, painful, enlarged ovaries and tubes are palpated (due to the accumulation of fluid in them).

Chronic adnexitis without exacerbation is characterized by the presence of tightness in the uterine appendages, dense stationary ovaries, shortening of the vaginal arches.

Diagnostics

Diagnosis of adnexitis is based on the collection of anamnesis, complaints, gynecological examination. The following laboratory tests are also shown:

  • general blood and urine analysis;
  • biochemical blood test ( C-reactive protein , blood sugar, total protein, etc.);
  • smear of vaginal secretions on flora, tank. seeding and antibiotic susceptibility studies;
  • Ultrasound of the pelvic organs ;
  • laparoscopy (in difficult cases);
  • tuberculin test (for suspected tuberculous infection).

Differential diagnosis of adnexitis is performed with ovarian cysts, external endometriosis, appendicitis, and lumbar osteochondrosis.     

Adnexitis treatment

The treatment of adnexitis is performed by a gynecologist.

Acute treatment

Patients with acute and acute exacerbation of chronic adnexitis are hospitalized. Calm, hypoallergenic diet and cold on the lower abdomen (to limit the inflammatory process and relieve pain) are prescribed.  

First of all, it is recommended to carry out therapy with a broad-spectrum antibiotic:

  • cephalosporins ( kefzol, ceftriaxone ),
  • penicillins ( ampioks, ampicillin),
  • fluoroquinolones (ciprofloxacin),
  • tetracyclines ( doxycycline ),
  • aminoglycosides (gentamicin) and others.

Antibacterial treatment is carried out within 7-10 days.

Additionally assigned disintoxication therapy (intravenous phys. Saline, glucose), and anti-inflammatory drugs locally (in rectal suppositories) and orally ( indomethacin, diclofenac).

Also shown is the intake of vitamins, anti-allergic and antifungal drugs.

Chronic treatment

Chronic adnexitis and rehabilitation after an acute process provides

  • receiving absorbable drugs (trypsin, wobenzym ),
  • receiving immunity stimulants ( Taktivin, vitreous body, aloe extract)
  • physiotherapy.

Physical therapy includes medicinal electrophoresis (with lidaza, aloe, plasmol and other drugs), UV irradiation, UHF and ultrasound on the lower abdomen.  

In case of chronic adnexitis, therapeutic mud, paraffin therapy, therapeutic baths and irrigation with mineral waters are effective, and sanatorium-resort therapy is recommended.

Complications and prognosis

Untreated or inadequately treated acute adnexitis leads to a chronic process. Possible complications of chronic adnexitis:

  • infertility (developed due to obstruction of the fallopian tubes and chronic anovulation );
  • the development of adhesions up to intestinal obstruction; 
  • ectopic pregnancy;
  • the threat of miscarriage and miscarriage;
  • inflammation of neighboring organs ( pyelonephritis, cystitis, colitis ).  

The prognosis for acute and chronic adnexitis is favorable for life. In the chronic process, infertility occurs in 50% of patients.

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