Hemorrhagic salpingitis

　　1, Etiology

　　It is not very clear. The etiological microorganism of hemorrhagic salpingitis is unknown, and it may also be subclinical infection caused by gynecological surgery, especially post-abortion, accompanied by varying degrees of cervical or uterine cavity adhesions, leading to retrograde blood flow of menstrual blood or fallopian tube bleeding into the abdominal cavity. It is also related to obstetric and gynecological surgery, especially in recent months (2 months) with induced abortion, and is also related to the operator's weak concept of asepsis and rough actions; salpingography, repeated hooking and clamping of the fallopian tube during small incision salpingectomy, etc., leading to this disease. In addition, when opening the abdomen, active bleeding at the ostium of the fallopian tube in retrograde blood flow cannot exclude the possibility of hemorrhagic salpingitis.

　　2, Pathogenesis

　　It is speculated that certain bacteria, especially anaerobic bacteria or viruses, may act as opportunistic pathogens in the potential deep reproductive organs, causing immune imbalance during gynecological, family planning surgery, pregnancy, delivery, or menstruation, leading to salpingitis, increasing vascular permeability, and causing bleeding in the stroma layer of the fallopian tube.

　　Severe cases may present with symptoms such as dizziness and palpitations. There may also be nausea, vomiting, and other reactions similar to early pregnancy, and severe cases may have pale face and fainting. Laparoscopic examination may show peritoneal effusion, one or both fallopian tubes thickened, congested, edematous, or adherent to surrounding tissues. There may be active bleeding at the fimbria of the fallopian tube, without signs of ectopic pregnancy implantation mass or massive bleeding, and hemorrhagic shock may occur.

　　1, Symptoms:Most patients have a history of delivery, intrauterine manipulation, and gynecological examination; no sexual history before onset, can have a history of amenorrhea, mainly manifested as irregular vaginal bleeding, lower abdominal pain accompanied by anal坠胀 sensation, abdominal pain starts from one side of the abdomen, and then the whole lower abdomen presents persistent pain, the time from abdominal pain to visit varies from a few hours to 10 days, with an average of 48h, most have a history of amenorrhea, most intra-abdominal bleeding does not exceed 200ml, severe cases may present with dizziness, palpitations, and other symptoms, and also nausea, vomiting, and other reactions similar to early pregnancy, severe cases may have pale face, fainting.

　　2, Signs:Fever, rapid pulse rate, lower abdominal pain, rebound pain, severe cases may present with positive shifting dullness, hypotension. Gynecological examination: cervical tenderness, posterior fornix tenderness, adnexal tenderness, or thickening or mass.

　　There are many causes of infertility, among which infertility caused by fallopian tube lesions accounts for about 30％~44％. Salpingitis-induced fallopian tube obstruction is especially the major cause of infertility.

　　The site where inflammation first occurs is often the endometrium of the fallopian tube, causing edema, interstitial edema, congestion, and exudation. The mucosal epithelium of the fallopian tube sheds due to inflammation, causing the mucosa to adhere to each other, or the fimbria of the fallopian tube to adhere, leading to lumen occlusion and infertility.

　　During the acute phase of salpingitis, the main symptoms are lower abdominal pain, abdominal distension, fever, increased vaginal discharge, or irregular vaginal bleeding. At this time, the main treatment method is bed rest and semi-recumbent position to localize the inflammation, provide adequate nutrition and fluid, and select effective antibiotics. Antibiotics must be taken in sufficient quantity, and medication should continue for two weeks after the inflammation subsides to consolidate the efficacy and avoid the formation of chronic inflammation.

　　If chronic, and there is suspicion of wall adhesion or lumen occlusion, treatment should not be abandoned. After treatment with the aforementioned methods, X-ray hysterosalpingography can be performed to determine the patency of the fallopian tubes. If it is not patent, it is necessary to first identify the site of blockage, and then select an appropriate surgical method according to the different lesion sites and the extent of adhesion and blockage to ensure success rate. If there is obstruction at the isthmus, isthmus, and ampulla of the fallopian tube, the minimally invasive interventional recanalization technique under X-ray should be preferred, with a high recanalization rate. If there is hydrosalpinx at the fimbria, tubal ostomy can be performed under laparoscopy or open surgery. If the fallopian tubes are patent but not patent, selective tubal cannulation and recanalization under X-ray can be performed according to the specific situation of the hysterosalpingography. Whether pregnancy can be achieved after surgery depends on the patency and degree of patency of the fallopian tubes after treatment. If they are completely patent and the function is restored, normal fertility can be restored. If they are still completely patent after surgery, pregnancy cannot be achieved. In that case, it is only possible to use in vitro fertilization and embryo transfer to realize the dream of having a child.

　　Prognosis:

　　Acute salpingo-oophoritis should be diagnosed and treated promptly, with a good prognosis. Mild simple salpingitis can usually lead to a decrease in body temperature in 2-3 days after treatment, the edema of the fallopian tube disappears in about a week, and the thickened fallopian tube is completely absorbed within 1-2 months. The folds and cilia of the fallopian tube can return to normal, without affecting fertility. Other types of salpingitis are difficult to completely absorb, and most leave varying degrees of salpingitis and peritoneal adhesions. The narrowed and tortuous fallopian tube wall, lumen obstruction, adhesion and closure of the ostium, and functional damage can cause infertility. However, the mucosal damage of interstitial salpingitis is relatively mild, although the wall lesion is severe, the fallopian tube lumen may reopen after a long time. However, the destruction of the folds and cilia, partial narrowing of the lumen, once pregnant, due to poor peristalsis, the transfer of the oocyte is slow, which becomes the cause of ectopic pregnancy (also known as extrauterine pregnancy). Some may develop into chronic diseases for various reasons.

　　1, Blood routine: hemoglobin value is within the normal range, blood white cell count and neutrophils are elevated.

　　2, Urine pregnancy test is negative.

　　3, Microbial culture and drug sensitivity test.

　　4, B-ultrasound examination shows adnexal mass and peritoneal effusion.

　　5, The postcervical fornix puncture extracts coagulated blood-like fluid, less than 1ml, more than 5ml, pale red or resembling bloodwater, rarely dark red or old blood.

　　6, Laparoscopic examination: see blood accumulation in the peritoneal cavity, one or both fallopian tubes are thickened, congested, edematous, or adherent to the surrounding tissues, which may indicate active bleeding at the ostium of the fallopian tube, without signs of ectopic pregnancy or massive hemorrhage.

　　Therapeutic diet for hemorragic salpingitis:

　　1, Leonurus sibiricus stewed meat

　　Ingredients: 30 grams of Leonurus sibiricus, 150 grams of lean pork.

　　Preparation method: Leonurus sibiricus is first stewed for about 1 hour, then the residue is filtered out, and the pork is stewed with the soup.

　　Nutritional effects: Leonurus sibiricus can promote blood circulation and open meridians, which is often used to treat salpingitis and endometritis, and is also beneficial to the activity of the smooth muscle of the fallopian tube.

　　2, Spatholobus suberectus stewed with spareribs

　　Ingredients: 300 grams of Spatholobus suberectus, 150 grams of pork vertebrae or ribs.

　　Preparation method: (1) First, soak the Spatholobus suberectus in hot water, stir to accelerate the dissolution of the gelatin, then remove the residue and boil it in clean water to dissolve the remaining gelatin. After that, mix the two kinds of gelatin, boil it, and place it in the refrigerator for 10 times in advance. (2) Take a portion of Spatholobus suberectus glue, add pork vertebrae or ribs, and simmer for more than 1 hour to extract the natural bone gel.

　　Nutritional benefits: Chongxue vine is slightly bitter and acrid, can activate blood and regulate the menstrual cycle, nourish blood and activate the collateral channels, and can inhibit platelet aggregation, with certain anti-inflammatory effects, belonging to the range of Chinese medicine's blood-activating and blood-circulating herbs; the natural gelatin in the pork spine and ribs has a nourishing yin effect.

　　3. Chuanxiong Stewed Chicken

　　Ingredients: Chuanxiong 15 grams, chicken 300 grams.

　　Preparation method: First, crush Chuanxiong, add an appropriate amount of water with chicken, and steam-cook for 1 hour, which can be seasoned at will.

　　Nutritional benefits: Chuanxiong is slightly sweet and bitter, can stop bleeding (shorten clotting time), can dissolve blood stasis, and has anti-inflammatory effects; chicken contains various components that have a beneficial effect on the human body.

　　Prevention: The consequences of acute salpingitis are serious, as the treatment is not sought in a timely manner, it takes a long time to treat, and it is more difficult to cure, causing great harm to women's physical and mental health. Therefore, the key to reducing the incidence of this disease is to do a good job of prevention work in advance, take the initiative, and do the following points to prevent the invasion of pathogens.

　　27. When having sexual intercourse, women should pay attention to their own and their sexual partner's personal hygiene. Before having sexual relations, the external genitalia of both men and women should be washed to prevent the smooth invasion of bacteria. When women have vaginal bleeding, they should self-restrain and prohibit sexual activity.

　　26. Women should pay attention to their vulvar hygiene and personal cleanliness; prevent infections from household utensils and toilets.

　　25. Women of all ages should pay attention to their own nutrition and health care, strengthen nutrition during the menstrual period, after induced abortion, and after delivery; enhance their physical fitness, increase their resistance and immunity, and reduce the chance of getting sick.

　　24. When undergoing surgical procedures such as induced abortion, delivery, placement or removal of intrauterine devices, and other uterine cavity procedures, strict sterilization should be carried out to avoid introducing bacteria into the vagina and uterus through surgery, causing artificial infection.

　　23. Women with acute salpingitis should rest in a semi-recumbent position to prevent and limit the flow of inflammatory fluid due to changes in body position. Eat high-nutrient, easy-to-digest, vitamin-rich foods.

　　22. Once a woman has a pelvic inflammatory disease, she should adhere to the principles of treatment, adopt a positive attitude, be thoroughly treated, control the condition as soon as possible, and prevent it from becoming chronic.