Adneksit (salpingooforit) – inflammatory process with simultaneous involvement of ovaries and uterine tubes (uterus appendages). In the sharp period it is characterized by pain in the bottom of a stomach, more intensively from an inflammation, the increased temperature, symptoms of intoxication. Violation of menstrual function can be observed. In a chronic stage the clinic is less expressed, there is periodic recurrence of a disease. Conducts to formation of solderings and unions in uterine tubes, increases probability of extra-uterine pregnancy and infertility.
Adneksity or salpingoofority one is called - or the bilateral, combined inflammation of the ovaries and fallopian (uterine) pipes forming uterus appendages. In structure of inflammatory diseases of the female sexual device the inflammation of appendages (adneksit) is high on the list. The inflammation of appendages can be caused by streptococci, enterokokka, stafilokokka, gonokokka, fungi, viruses, tuberculosis mikobakteriya, escherichias, hlamidiya and other microorganisms. Often as the reason of an adneksit serve microbic associations (usually colibacillus and staphylococcus). As a rule, activators of an adneksit are steady against many antibiotics.
Tubercular stick, the bilateral inflammation of appendages, a streptococcus, staphylococcus and colibacillus - unilateral usually cause. Overcooling, STD infection, non-compliance with hygienic norms, stresses, chaotic sexual communications contribute to development of an inflammation of appendages or its recurrence.
Mechanism of development of an adneksit
Development of inflammatory process at an adneksita begins with introduction of the infectious agent in a mucous membrane of a uterine tube with gradual involvement of muscular and serous layers. Further the inflammation extends to surrounding fabrics: integumentary epithelium of an ovary and pelvic peritoneum. Right after an ovulation the infection gets to the burst follicle or a yellow body, developing further in an ovary. At you adneksit an ovary and a pipe are accustomed to drinking together with formation of a uniform inflammatory conglomerate, and then and tuboovarialny abscess. An outcome of an inflammation of appendages is development of the numerous solderings limiting passability of uterine tubes.
Activators of pathological process at an adneksita can get to pipe fallopiyeva the next ways:
- hematogenic (with blood current);
- limfogenny (with lymph current);
- descending (from a sigmovidny or blind gut on a peritoneum);
- ascending (from a vagina to the tservikalny canal, then in a uterus cavity, uterine tubes and ovaries).
Hematogenic infection of appendages at an adneksita happens in cases of tubercular damage of genitals, limfogenny and descending – at diseases of a direct, sigmovidny gut and worm-shaped shoot of a blind gut. For colibacillus, streptococci, stafilokokk as entrance gate serve the ascending anatomic channels of a genital tract. Hlamidiya and gonokokk are capable to get through the intact tissues of a genital tract. Quite often the infection gets to appendages in several ways at the same time. The current of an adneksit can be sharp, subsharp, chronic (without recurrence and recuring).
Diagnostics of an adneksit
Data of the anamnesis (introduction of an intrauterine spiral, abortions, carrying out a diagnostic scraping, the complicated childbirth, factors which entailed an aggravation of an inflammation of appendages etc.), the shown complaints and results of objective researches form the bases for diagnosis at an adneksita. At a two-handled gynecologic research at an adneksita one is defined - or bilateral painful increase in appendages of a uterus. The adneksita allows to establish the microbic activator and a research of dabs of an urethra, vagina and neck of a uterus.
Ultrasonic diagnostics at an adneksita reveals inflammatory educations (gidrosalpinksa, piosalpinksa) appendages. As the diagnostic method for identification of purulent educations and survey of uterine tubes with simultaneous holding intracavitary medical procedures at an inflammation of appendages is used a laparoscopy.
For the purpose of definition of passability of uterine tubes and degree of expressiveness the gisterosalpingografiya – a radiological research of a uterus and appendages with introduction of contrast substance is carried out to them pathological changes at a chronic adneksit. In cases of violation of a menstrual cycle at an inflammation of appendages for assessment of function of ovaries functional tests are carried out: measurement of rectal temperature, definition of a symptom of a pupil, tension of tservikalny slime.
Symptoms of a sharp adneksit
The sharp form of an adneksit proceeds with a characteristic clinical picture: the intensive, sharp pains in the bottom of a stomach giving to back pass, a sacrum and which were more expressed on the party of an inflammation the increased temperature which is quite often followed by a fever, emergence of unusual mucous or purulent allocations, weakness, weakness, dizurichesky frustration, an abdominal distension. At a palpation of a stomach symptoms of muscular protection (irritation of a peritoneum) are noted. In a blood count acceleration of SOE is noted with shift to the left.
Often the bilateral inflammation of appendages which is combined with a uterus inflammation develops. Adneksit can be followed algomenorey and menorragiy. At increase of inflammatory changes there is a formation of a purulent meshotchaty tumor in the field of appendages – tuboovarialny abscess. At an abstsedirovaniye there is a risk of a rupture of a fallopian pipe and hit of purulent contents in an abdominal cavity with development of a pelvioperitonit. At severe intoxication in a sharp phase of an adneksit there can be changes from nervous, vascular systems.
The expressed symptoms at an uncomplicated form of a sharp adneksit remain 7-10 days, then pain gradually weakens, blood and body temperature are normalized. As an outcome of an acute inflammation of appendages absolute clinical recovery (can serve at adequately and in due time carried out treatment) or synchronization of process with a long current.
Stages of a sharp adneksit
In development of a sharp adneksit four consecutive stages are noted:
- stage of a sharp endometritis and salpingit without symptoms of irritation of a pelvic peritoneum;
- stage of a sharp endometritis and salpingit with symptoms of irritation of a pelvic peritoneum;
- the stage of a sharp adneksit which is followed by development of an inflammatory conglomerate and an abstsedirovaniye;
- rupture of tuboovarialny abscess.
The current of a sharp adneksit passes two phases:
- Toxic - with prevalence of aerobic flora and symptoms of intoxication.
- Septic – with accession of anaerobic flora, weighting of symptoms of an adneksit and development of complications. In a septic phase of an adneksit there is a formation of purulent tuboovarialny education to perforation threat.
Treatment of a sharp adneksit
The sharp stage of an inflammation of appendages is subject to hospitalization with creation of conditions for physical and mental rest of the patient, purpose of easily usvoyaemy diet, adequate amount of liquid (alkaline drink, a fruit drink, tea), observation of secretory function. At a sharp adneksit it is appointed: antibacterial treatment by medicines of a broad spectrum of activity, anesthetic, the anti-inflammatory, desensibilizing treatment.
As fixed assets of therapy of an adneksit serve antibiotics taking into account sensitivity of the activator to medicine. The dose of antibacterial medicine has to provide its maximum concentration in the inflammatory center. In treatment of an inflammation of appendages antibiotics of the following groups are widely used:
- penicillin (ampicillin, );
- tetratsiklin ( and );
- ftorkhinolon (, etc.);
- macroleads (, erythromycin, );
- aminoglycosides (, gentamycin);
- nitroimidazoles (metronidazole);
- linkozamid ().
Preference is given in antibacterial therapy of an adneksit to antibiotics of a long half-life period and removal (ampicillin — 5 hours, amoxicillin — 8 h, etc.). At a heavy clinical current of an inflammation of appendages, risk of development of septic complications, the mixed or anaerobic flora antibiotics in various combinations are appointed (gentamycin + levomitsetiny, + chloramphenicol, lincomycin + , penicillin + aminoglycosides). Metronidazole has bactericidal effect on anaerobic flora (it is appointed intravenously or orally). For removal of symptoms of intoxication at an adneksita infusional therapy is appointed: intravenous administration of solutions of glucose, a dextran, proteinaceous medicines, water-salt solutions (the total amount of liquid is up to 2-2,5 l/days).
At development of purulent forms of an inflammation expeditious treatment of an adneksit is shown. Today the surgical gynecology widely applies low-traumatic methods of carrying out operations including at treatment of an adneksit. So, at a sharp purulent adneksit the laparoscopy during which pus is removed is carried out and irrigation is carried out by antiseptics and antibiotics of the center of an inflammation. Evacuation of contents of a meshotchaty tumor by method of a puncture of the arches of a vagina and the subsequent local introduction of antibiotics is successfully applied. In some cases at development of purulent fusion of appendages (increase of a renal failure, threat of opening of an abscess, generalization of septic process) their expeditious removal (adneksektomiya) is shown.
After removal of sharp symptoms of an adneksit, in a subsharp phase are appointed physical therapy (ultrasound, an electrophoresis with magnesium, potassium, zinc to a stomach bottom, vibromassage) and biostimulators. In the absence of timely medical actions sharp adneksit passes into the chronic inflammation of appendages proceeding with periodic aggravations.
Symptoms of a chronic adneksit
Chronic adneksit most often is result of undertreated sharp process and proceeds with the recurrence resulting from influence of nonspecific factors (stressful situations, overcooling, overfatigue etc.). The periods of an aggravation of a chronic inflammation of appendages proceed with deterioration in the general health of the woman, weakness, emergence or strengthening of pains in the bottom of a stomach, temperature increase of a body to 37 — 38 °, emergence of mucopurulent allocations from a genital tract. In 5-7 days symptoms of an adneksit gradually calm down, the moderate aching or dull ache in a stomach remains only.
At 50% of patients with a chronic adneksit short-term or permanent violations of a menstrual cycle on type of a menorragiya, metrorragiya, algomenorea, seldom oligomenore are observed. At 35-40% of women with a chronic adneksit disorder of sexual function (morbidity is observed at sexual intercourse, decrease or lack of sexual desire etc.). At a chronic inflammation of appendages function of digestive organs (colitis, etc.) and urinations (cystitis, a bakteriuriya, pyelonephritis) is broken. A frequent recurrence of an adneksit leads to development of neurosises, decrease in working ability of the woman, emergence of conflict situations in a family.
Options of a current of a chronic adneksit
The aggravation of a chronic adneksit can proceed by two options:
- to infectious and toxic - with increase in pathological secretion, ekssudativny processes in uterus appendages, strengthening of their morbidity, changes in a blood count;
- to neuro and vegetative – with deterioration in health, decrease in working capacity, instability of mood, vascular and endocrine disorders.
Complications of a chronic adneksit
The chronic recidivous inflammation of appendages often leads to development of pathological result of pregnancy (extra-uterine pregnancy, a spontaneous abortion), secondary infertility. Infertility at a chronic adneksit can be not only a consequence of anatomic and functional changes in uterine tubes, but also dysfunction of ovaries (frustration of a menstrual cycle, an anovulyation etc.). Such mixed infertility forms arising owing to an inflammation of appendages will extremely difficult respond to treatment.
At a chronic adneksit formation of infiltrates, development of sclerous processes in uterine tubes and their impassability, formation of adhesive processes around ovaries is noted. From the chronic center at an adneksita the infection can extend to other bodies and cause chronic colitis, cholecystitis, pyelonephritis.
Treatment of a chronic adneksit
In a stage of an aggravation of a chronic adneksit the medical events corresponding to sharp process (hospitalization, the antibacterial, infusional, desensibilizing therapy, vitamins) are held. After subsiding of an aggravation of an inflammation of appendages carrying out an autogemoterapiya, injections of an aloe, physical therapy (UF-radiation, an electrophoresis with medicines (a lidaz, potassium, iodine, magnesium, zinc), UVCh-therapies, ultrasound, vibromassage) under control of laboratory and clinical indicators are recommended.
The physiotherapeutic procedures applied at an inflammation of appendages reduce an ekssudation of fabrics, possess the rassasyvayushchy and anesthetizing action, promote reduction of formation of solderings. Are effective at a chronic inflammation of appendages therapeutic muds (ozokerite), parafinolecheny, medical bathtubs and vaginal irrigations with hloridno-sodium, sulfide mineral waters. In a stage of permanent remission of an adneksit resort treatment is shown.
Diet at an adneksita
Observance of a diet at an inflammation of appendages strengthens resistance of an organism to infectious agents, improves exchange processes in the inflammation center. In the period of a sharp and subsharp stage of an adneksit appoint the hypoallergic diet excluding proteins of eggs, mushrooms, chocolate, sweets etc. and limiting amount of table salt and carbohydrates. The general caloric content of a daily diet includes 100 g of proteins, 70 g of fats, 270-300 g of carbohydrates (2300 kcal a day). The heat treatment of food recommended at an adneksita – cooking or suppression.
Out of an aggravation of an adneksit strict observance of a diet is not obligatory, however food has to be balanced and rational with the sufficient use of protein and vitamins.
Prevention of an adneksit
The women having sexually transmitted infections, using the intrauterine contraceptives which underwent reproductive organ operations and also after the pregnancies which ended with artificial or spontaneous abortions enter into risk group on development of an adneksit. The threat of development of consequences of an adneksit indicates the need cares of the health and acceptance of timely preventive measures:
- exception of the factors provoking development of a sharp adneksit and a recurrence of a chronic inflammation of appendages (overcoolings, stresses, sexually transmitted infections, abuses of alcohol, spicy food etc.);
- use of rational contraception, prevention of abortions;
- if necessary - medicamentous termination of pregnancy or performing miniabortions;
- performing timely, rational and full complex therapy of inflammatory diseases of bodies of a small pelvis, including inflammation of appendages, taking into account the activator;
- systematic consultations of the gynecologist each 6-12 months.