Chronic salpingo-oophoritis

　　The pathological types of chronic salpingo-oophoritis can be roughly divided into 4 types: hydrosalpinx, hydrosalpinx of pus, adnexitis mass, and interstitial salpingitis.

　　1. Hydrosalpinx and fallopian tube ovarian cyst:Hydrosalpinx is caused by the blockage of the fimbria due to endometritis of the fallopian tube, leading to the accumulation of exudate in the lumen. In some cases, it may develop into hydrosalpinx due to the absorption and liquefaction of pus over time, which appears as serous fluid. If the original condition is a fallopian tube ovarian abscess, it may form a fallopian tube ovarian cyst (hydrosalpinx). In addition, sometimes, due to peritoneal inflammation around the ovary, the follicle rupture is obstructed, leading to the formation of a follicular cyst, or bacteria may enter through the rupture of the follicle, forming inflammatory effusion. Later, it may communicate with the hydrosalpinx to form a fallopian tube ovarian cyst. Hydrosalpinx is usually not very large, with a diameter below 15 cm, and it has a curved-neck bottle-like shape like hydrosalpinx. The diameter of the hydrosalpinx ovarian cyst can reach about 10-20 cm. Both are seen in cases with chronic inflammation that does not recur. The surface is smooth, and the tube wall becomes thin and translucent due to expansion. Hydrosalpinx usually has delicate membrane-like strands adhering to the pelvic peritoneum, but some are free. Due to the heavier distal expansion, occasionally, the proximal part (isthmus) becomes the axis, leading to torsion of the hydrosalpinx, which is more common on the right side. Hydrosalpinx is often bilateral. Sometimes, the uterine end is only loosely obstructed, so when performing hysterosalpingography, X-ray fluoroscopy or filming can show typical hydrosalpinx images; a few cases report occasional sudden or intermittent discharge of a large amount or small amount of fluid from the vagina, which may be due to increased intracavity pressure of the hydrosalpinx, causing the effusion to be discharged through the loosely obstructed ostium of the fallopian tube. After a large amount of vaginal discharge, pelvic examination may reveal the disappearance of the original mass.

　　2. Fallopian tube abscess, fallopian tube-ovary abscess:If the fallopian tube abscess does not subside for a long time, it can recur acutely. Especially when closely connected with the intestines in the pelvis, Escherichia coli can penetrate and cause secondary mixed infection. When the body's resistance is weakened, the residual fallopian tube abscess can also be stimulated by external factors. If the patient is too tired, has sexual intercourse, 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, the 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 adhere to the intestines, 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 uterine stump, become the center, and the intestines, omentum, etc., adhere to them. If it has become a chronic inflammatory mass, it is relatively difficult to completely dissipate the inflammation or make the mass completely disappear.

　　4. Chronic interstitial salpingitis:Chronic inflammatory lesions left by acute interstitial salpingitis, often coexisting with chronic ovarian inflammation. Bilateral fallopian tubes can become thickened and fibrotic, with small abscesses remaining in the muscular layer and subperitoneal space. Clinical manifestations include thickening or string-like thickening of the adnexa. Microscopy shows extensive infiltration of lymphocytes and plasma cells in all layers of the fallopian tube. In addition, a kind of isthmus nodular salpingitis can form, which is a residual lesion of chronic salpingitis. The lesions are mainly localized to the isthmus of the fallopian tube. In such cases, there are obvious nodules in the isthmus, and the nodules may sometimes be very large, resembling small fibrous tumors similar to the uterine horn. Microscopy shows abnormal thickening of the muscular layer, and the lumen endometrial folds can be separately rolled into the muscular layer, resembling endometriosis, which can be distinguished from its lack of endometrial stroma. Some muscular layers have infiltration of lymphocytes and plasma cells.

　　Chronic salpingo-ovarian inflammation can present as inflammatory fibrosis hyperplasia, forming relatively solid inflammatory masses. Generally smaller, if they adhere to the intestines, 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 uterine stump, become the center, and the intestines, omentum, etc., adhere to them. If it has become a chronic inflammatory mass, it is relatively difficult to completely dissipate the inflammation or make the mass completely disappear.

　　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 symptoms can be highly suspected. If only the parauterine tissue is slightly thickened without a mass is found during examination, a hydrosalpingogram can be performed. If the fallopian tube is proven to be blocked, the diagnosis of chronic salpingitis can be basically established.

　　One, Abdominal Pain

　　Pain in the lower abdomen of varying degrees, mostly a sense of hidden discomfort, lumbar and sacral pain, distension, and a sense of falling, often exacerbated by fatigue. Due to pelvic adhesions, there may be bladder or rectal filling pain or emptying pain, or other bladder and rectal stimulation symptoms, such as frequent urination, urgency, etc.

　　Two, Irregular Menstruation

　　The most common is frequent menstruation and excessive menstrual blood volume, which may be the result of pelvic congestion and ovarian dysfunction. Due to chronic inflammation, uterine fibrosis, incomplete uterine involution, or adhesions causing abnormal uterine position, etc., all can cause excessive menstrual blood volume.

　　Three, Infertility

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

　　Four, Dysmenorrhea

　　Due to pelvic congestion, it causes dysmenorrhea with blood stasis, most of which starts with abdominal pain one week before the menstrual period, and becomes more severe as the menstrual period approaches, until the menstrual period comes.

　　Five, Other

　　Symptoms such as increased leukorrhea, sexual intercourse pain, gastrointestinal disorders, fatigue, affected by labor or unable to endure long labor, symptoms of mental and nervous disorders, and depression, etc.

　　Six, Signs

　　1. Abdominal examination:In addition to mild tenderness in the lower abdomen, there are rarely other positive findings.

　　2. Gynecological examination:The cervix often has erosion and inversion, with mucopurulent leukorrhea. The uterus is often retroverted or retroflexed, with less mobility than normal. Generally, there is pain when moving the cervix or uterus. In mild cases, only thickened cord-like fallopian tubes can be felt bilaterally in the adnexa; in severe cases, irregular and fixed masses of different sizes can be palpated bilaterally in the pelvis or posterior to the uterus, with tenderness, thick walls and adhesions. Severe cystic masses are mostly abscesses; those with thin walls, high tension, and slight mobility are mostly hydrosalpinx.

　　The pathological types of chronic salpingo-oophoritis can be roughly divided into 4 types: hydrosalpinx, hydrosalpinx of pus, adnexitis mass, and interstitial salpingitis.

　　1. Hydrosalpinx and tubo-ovarian cyst (Hydrosalpinx and tubo-ovarian cyst) Hydrosalpinx is caused by endometritis of the fallopian tube, leading to closure of the ostium, and the accumulation of exudate in the lumen. Some are hydrosalpinx of pus, and after a long time, the pus is absorbed and liquefied, showing a serous state, and evolves into hydrosalpinx. If it is originally a tubo-ovarian abscess, it forms a tubo-ovarian cyst (hydrosalpinx). In addition, sometimes, due to peri ovarian inflammation, the follicle rupture is blocked and forms a follicular cyst, or bacteria enter when the follicle ruptures, forming inflammatory effusion, and later connecting with hydrosalpinx to form a tubo-ovarian cyst.

　　2. Hydrosalpinx is often not very large, with a diameter of less than 15 cm, similar to hydrosalpinx of pus, showing a curved neck bottle shape. The diameter of hydrosalpinx and ovarian hydrosalpinx can reach about 10-20 cm. Both are seen in cases of inflammation that have not recurred for many years. The surface is smooth, and the tube wall is thin and transparent due to expansion. Hydrosalpinx usually has delicate membrane-like strands adherent to the pelvic peritoneum, but some are free. Due to the heavy expansion at the distal end, it occasionally twists around the proximal end (isthmus) as an axis, and torsion of the hydrosalpinx occurs, 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; in a few cases, patients report occasional sudden large or intermittent small amounts of fluid discharged from the vagina, which may be due to increased intracavitary pressure of 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.

　　1. Abdominal examination:In addition to mild tenderness in the lower abdomen, there are rarely other positive findings.

　　2. Gynecological examination:The cervix often has erosion and inversion, with mucopurulent leukorrhea. The uterus is often retroverted or retroflexed, with less mobility than normal. Generally, there is pain when moving the cervix or uterus. In mild cases, only thickened cord-like fallopian tubes can be felt bilaterally in the adnexa; in severe cases, irregular and fixed masses of different sizes can be palpated bilaterally in the pelvis or posterior to the uterus, with tenderness, thick walls and adhesions. Severe cystic masses are mostly abscesses; those with thin walls, high tension, and slight mobility are mostly hydrosalpinx.

　　Poria Plantago Congee:Poria 15 grams, Plantago 10 grams, rice 100 grams, and appropriate amount of brown sugar. 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 to serve. This recipe has the effects of invigorating the spleen and Qi, and removing dampness.

　　Firstly, prevention

　　Actively and thoroughly treating acute salpingo-ovarian inflammation 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 and being difficult to cure. In daily life, attention should be paid to personal hygiene and the health of the menstrual period to prevent chronic infection. In addition, due to the stubborn nature of the disease and its tendency to recur, it often causes patients to bear a heavy psychological burden, so it is necessary to build the confidence of the patients that they can win, maintain a pleasant mood, actively exercise, enhance physical fitness, and improve the ability to resist diseases.

　　Secondly, preoperative preparation

　　1. Indwelling catheter placement.

　　2. Anesthesia: Epidural anesthesia or lumbar anesthesia.