Tubo-ovarian abscess

　　The pathological types of chronic salpingo-ovarian inflammation can be roughly divided into four types: hydrosalpinx, pyosalpinx, adnexal mass, and interstitial salpingitis.

　　1. Hydrosalpinx and salpingo-ovarian cyst:Hydrosalpinx is caused by the closure of the ostium of the fallopian tube due to endometritis, and the accumulation of exudate in the lumen. Some are hydrosalpinges, and some become hydrosalpinx after the absorption and liquefaction of the pus for a long time, showing a serous state. If it is originally a salpingo-ovarian abscess, it forms a salpingo-ovarian cyst (hydrosalpinx).

　　In addition, sometimes, due to periphery ovarian inflammation, the follicle rupture is blocked and forms a follicular cyst, or bacteria enter during the rupture of the follicle, forming inflammatory effusion, and then it connects with the hydrosalpinx to form a salpingo-ovarian cyst. Hydrosalpinx is usually not very large, less than 15 cm in diameter, like hydrosalpinx,呈曲颈瓶状. The diameter of the salpingo-ovarian hydrosalpinx can reach about 10-20 cm. Both are seen in cases with inflammation for many years without recurrence. The surface is smooth, and the tube wall becomes thin and transparent due to expansion. Hydrosalpinx usually has delicate membranous strands adherent to the pelvic peritoneum, but some are free. Due to the heavier distal expansion, occasionally, the proximal (isthmus) is the axis, and the hydrosalpinx twists, which is more common on the right side.

　　Hydrosalpinx is often bilateral. Sometimes, the uterine end is only loosely occluded, so when performing hysterosalpingography, X-ray fluoroscopy or film can show typical hydrosalpinx images; a few cases report occasional sudden large or intermittent small amounts of fluid discharged from the vagina, which may be due to increased intracavitary pressure of the hydrosalpinx, causing the fluid to be discharged from the loosely occluded orifice of the fallopian tube. After a large amount of vaginal discharge, pelvic examination can reveal the disappearance of the original mass.

　　2. Hydrosalpinx and salpingo-ovarian abscess:If the hydrosalpinx does not subside for a long time, it can have recurrent acute attacks. Especially when closely connected with the intestinal tract in the pelvis, Escherichia coli can infiltrate and cause secondary mixed infection. When the body's resistance is weakened, the residual hydrosalpinx can also be stimulated by external factors. If the patient is too tired, has sexual activity, gynecological examination, etc., and has an acute attack. Recurrence can also occur before and after menstruation due to local congestion.

　　Due to repeated attacks, the fallopian tube wall becomes highly fibrotic and thickened, and adheres to adjacent organs (uterus, posterior leaf of the broad ligament, sigmoid colon, small intestine, rectum, pelvic floor, or pelvic lateral wall). If stable after treatment, pus can become increasingly thick and gradually replaced by granulation tissue, occasionally calcification or cholesterol stones can be found.

　　3. Adnexal mass:Chronic salpingo-ovarian inflammation can present as inflammatory fibrosis hyperplasia, forming relatively solid inflammatory masses. Generally smaller, if they are adherent to the intestinal tract, omentum, uterus, pelvic peritoneum, bladder, etc., they can form a large mass. The mass can also form after pelvic inflammatory surgery. At this time, the retained organs, such as the ovary or part of the fallopian tube, pelvic connective tissue, or the remnant of the uterus, are at the center, and the intestinal tract, omentum, etc., are adherent to them. If it has become a chronic inflammatory mass, it is relatively difficult to completely resolve the inflammation or make the mass disappear.

　　4, Chronic interstitial salpingitis:It is a chronic inflammatory lesion left by acute interstitial salpingitis, often coexisting with chronic ovarian inflammation. Bilateral fallopian tube thickening and fibrosis can be seen, and small abscesses may remain in the muscular layer and subperitoneum. Clinical manifestations include thickening or string-like thickening of the adnexa. Microscopic examination shows widespread infiltration of lymphocytes and plasma cells in all layers of the fallopian tube.

　　It is a chronic inflammatory lesion left by acute interstitial salpingitis, often coexisting with chronic ovarian inflammation. Bilateral fallopian tube thickening and fibrosis can be seen, and small abscesses may remain in the muscular layer and subperitoneum. Clinical manifestations include thickening or string-like thickening of the adnexa. Microscopic examination shows widespread infiltration of lymphocytes and plasma cells in all layers of the fallopian tube.

　　1, Ectopic pregnancy:Salpingo-oophoritis abscess can lead to adhesions, hydrops, or pyosalpinx, and if both sides occur, it can lead to infertility. Ectopic pregnancy is a dangerous acute abdominal condition in gynecology and must be highly vigilant.

　　2, Infertility:The fallopian tube itself is damaged by disease, causing obstruction and infertility, which is more common in secondary infertility.

　　1, Abdominal pain:There is pain in the lower abdomen to varying degrees, mostly a hidden discomfort, with soreness, swelling, and a sense of descent in the lumbar, sacral, and gluteal regions, which often worsens due to fatigue. Due to pelvic adhesions, there may be pain during bladder or rectal filling or emptying, or other bladder and rectal irritation symptoms, such as frequent urination, urgency, etc.

　　2, Irregular menstruation:The most common is frequent menstruation and excessive menstrual volume, which may be the result of pelvic congestion and ovarian dysfunction. Due to chronic inflammation causing uterine fibrosis, incomplete uterine involution, or adhesions leading to abnormal uterine position, etc., all of which can cause excessive menstruation. The menstrual period after sexual intercourse may also worsen. Due to pelvic congestion, it can cause blood stasis dysmenorrhea, mostly starting with abdominal pain one week before the menstrual period, becoming more severe as the menstrual period approaches, until menstruation arrives.

　　3, Infertility:The fallopian tube itself is damaged by disease, causing obstruction and infertility, which is more common in secondary infertility.

　　4, Other:Symptoms such as increased leukorrhea, sexual intercourse pain, gastrointestinal disorders, fatigue, and reduced work capacity or intolerance to prolonged labor, as well as malaise and fatigue.

　　If the above symptoms appear after acute pelvic reproductive organ inflammation, it can be considered as chronic adnexitis. Even without a history of acute illness, a series of such symptoms can be highly suspected. If only slight thickening of the parauterine tissue is found during examination without any mass, then a hydrotubation examination can be performed. If it is proven that the fallopian tube is blocked, the diagnosis of chronic salpingitis can basically be established.

　　Completely and thoroughly treating acute salpingo-oophoritis and pelvic peritonitis is the key to preventing the occurrence of this disease. If the disease has already occurred, it should be treated actively in cooperation with the doctor, and persistence is required to avoid the disease from lingering for a long time, making it difficult to cure.

　　1, In terms of hygiene, attention should be paid to personal hygiene and menstrual health during the period, in order to prevent chronic infection.

　　2, In terms of spirit, due to the stubborn nature of the disease and its tendency to recur, patients often bear a heavy psychological burden. Therefore, it is necessary to establish the confidence of patients in victory.

　　3, Keep the mood pleasant, be active in exercise, enhance the physique, and improve the ability to resist diseases.

　　1, Gynecological examination:It can be found that the position of the uterus is posterior and its movement is restricted. A cystic mass can be felt on one side or both sides of the uterus, which is less active and slightly painful when pressed.

　　2, Ultrasound examination:A liquid shadow area can be found on one side or both sides of the uterus, with a thick cyst wall and unclear surrounding boundaries.

　　3, Salpingography:For those with combined infertility, it should be checked for fallopian tube obstruction after the inflammation is controlled.

　　4, CA125:Distinguish from other pelvic tumors.

　　Dietary recipes for salpingo-ovarian abscess (the following information is for reference only, detailed information needs to be consulted with a doctor):

　　Fuling Cheqian Congee: Fuling 15 grams, Semen Plantaginis 10 grams, rice 100 grams, brown sugar in appropriate amount.

　　Put the first two ingredients in a gauze bag and boil with rice at the same time. After the congee is cooked, remove the medicine bag and add an appropriate amount of brown sugar for consumption. This formula has the effect of invigorating the spleen and Qi, and removing dampness.

　　Bupleurum 10 grams, Fructus Crataegi 15 grams, Angelica Sinensis 10 grams, sugar in appropriate amount.

　　Put the first three ingredients in the pot and boil together, remove the dregs and take the juice. Add an appropriate amount of sugar when taking, twice a day. This formula has the effect of regulating Qi and promoting blood circulation.

　　It is better to be treated in the hospital during treatment.

　　The patient needs to rest in bed, and the position should be semi-recumbent.

　　Symptomatic treatment to reduce body temperature.

　　Drink plenty of water, eat high-quality protein and various vegetables and fruits, to strengthen the physique.

　　The drug treatment should first use broad-spectrum antibiotics effective against anaerobic bacteria, such as metronidazole and third-generation cephalosporins, as treatment drugs.

　　If there is no significant improvement in the condition after medication, and there is still a large abscess focus in the pelvic cavity, consider surgical treatment after 2-3 days of antibiotic application.

　　If an acute peritonitis is triggered by the rupture of an abscess, immediate surgery is necessary.