Adnexitis (synonym oophoritis) is an inflammation of the uterus (the fallopian tubes and ovaries). Adnexitis often called strepto - and stafilokokkami, gonorrhea, E. coli, Mycobacterium tuberculosis; very rare disease occurs when released into the fallopian tubes of different chemical substances (iodine, alcohol and other). Infectious agents are usually penetrate into the uterus from the vagina, cervix and uterus; less often they spread through the blood vessels. Pathogens septic infection (stafilo - and streptococci) can be inserted into the uterus and then into the appendages during different intrauterine manipulation (artificial abortion, diagnostic scraping and so on). In the inflammatory process usually involves primarily the fallopian tubes (salpingitis), and then the ovaries (oophoritis). In a number of cases in process involves surrounding the peritoneum(periodicit). The accumulation transparent exudate in a lumen of the fallopian tube may cause the formation of hydrosalpinx, and the accumulation of pus - pyosalpinx. Adnexitis may be bilateral or unilateral.
Clinical presentation and course of adnexitis depend on the cause of the disease and the reactivity of the organism. Adnexitis septic and gonorrheal etiology can be acute, subacute, or chronic, for tuberculosis adnexitis typically chronic. Acute adnexitis characterized by strong pains in the lower abdomen and rump. In some cases the pain may be accompanied by phenomena of irritation pelvic peritoneum: swelling of the abdomen, nausea, vomiting, stool retention; palpation revealed a sharp pain in the lower abdomen, sometimes pronounced symptom muscle protection in the lower abdomen. Body temperature in acute adnexitis increases sometimes up to 39C, pulse quickens, respectively temperature. In blood leukocytosis, shift leukocyte left, acceleration ROHE. The most serious complications of adnexitis in this period are the transition process on the pelvic peritoneum with the development of pelvioperitonit (see) and the formation of an abscess of fallopian-pryamokishechnye space (see Douglas abscess). In the case of education pyosalpinx most dangerous is the gap of the fallopian tube, accompanied by penetration of pus in the abdominal cavity and the development of diffuse purulent peritonitis(see).
In uncomplicated cases, the phenomenon of acute adnexitis stay 7-10 days, then the process continues in the subacute phase. The pain gradually subside, the normalized temperature and the blood picture. The process is outlined spikes, appendages become available to palpation. When two handed the study noted the increase impaired mobility (adhesions). In some cases, adnexitis takes chronic. Patients report pain in the abdomen and groin area, smack in the sacrum and the anus. These are signs not so much adnexitis, how many of formation of growths around the fallopian tubes and ovaries. Adhesions in the fallopian tubes can lead to the violation of their cross and infertility. Chronic adnexitis tubercular etiology patients often complaints, characteristic for adnexitis, is not presented, calling for infertility. When adnexitis often observed menstrual irregularities - heavy and prolonged bleeding with the shortening of the cycle.
For adnexitis any etiology characterized by relapses. They can occur as a result of activation of dormant infection under the influence of exhaustion, hypothermia, etc.
When setting the diagnosis take into account the data of the anamnesis, the nature of pain, their localization, fever, tenderness to palpation of the uterus. To identify the etiology of inflammatory process conduct direct microscopic examination (smear discharge urethra and cervical), different methods of provocation (in case of gonorrhoea). For the diagnosis of tuberculous adnexitis use aspiration biopsy, diagnostic vysalivaniya, crops menstrual blood, hysterosalpingography (see), tuberculin tests - reactions pirquet, Mantoux test (see Tuberculosis).
Forecast for uncomplicated adnexitis in relation to the life of the patient is usually favorable. Childbearing most often violated when tuberculosis and gonorrheal adnexitis.
Treatment. In the acute stage of adnexitis required hospitalization. Patients require full peace, appoint mechanically and chemically light diet, ice on the lower abdomen, antibiotics, sulfa drugs, painkillers. Local treatment in this period is contraindicated. Chronic adnexitis and after the acute period not earlier than in 4 weeks shows treatment at mud cure resorts, and resorts with hydrogen sulphide and radon waters. Of the methods of physiotherapy is used for UV-irradiation, electrophoresis, inhalations, paraffin applications. When tuberculosis adnexitis specific treatment, carried out under the control of TB dispensary. Physiotherapy treatments are contraindicated.
Prevention. The warning adnexitis important role to play in combating crime (outpatient) abortion, prevention of sexually transmitted diseases (gonorrhoea), the correct maintenance of the postnatal period (prevention of infections). To prevent the aggravation of adnexitis, it is necessary to recommend the patient to avoid cooling, fatigue, and increased physical activity.