Adnexitis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
N70 Salpingitis and oophoritis
N70.0 Acute salpingitis and oophoritis
N70.1 Chronic salpingitis and oophoritis
ICD-10 online (WHO version 2019)

When pelvic inflammatory disease is an inflammation of the so-called adnexal (dt .: appendages). As a rule, the term is used in gynecology and describes the combination of inflammation of the fallopian tubes (Latin Tuba uterina , Greek salpinx , inflammation salpingitis ) and the ovary (Latin ovary , Greek oophoron , inflammation oophoritis ). The term oophorosalpingitis can also be used as a synonym for adnexitis . A collection of pus in the fallopian tube is called a pyosalpinx .

Adnexitis can be unilateral or bilateral. Acute adnexitis is associated with significant pain in the lower abdomen. If the acute inflammation does not heal or if the healing leads to scarring and adhesions, symptoms can appear for years. The acute one has then turned into a chronic adnexitis. Pain in the lower abdomen or back occurs again and again, especially during intercourse or menstruation. Constipation or a general reduction in performance, fatigue and loss of appetite can also be the result. Chronic adnexitis often causes only a few symptoms, but can be the cause of chronic infertility . The spectrum of pathogens can be large, but currently infections caused by chlamydia can be found in almost 40 percent of cases . Adnexitis and other inflammations in the pelvic area ( cervicitis , endometritis ) are also summarized under the term pelvic inflammatory disease ( abdominal inflammation ).

The concept of adnexitis, which is relatively imprecise with regard to the anatomical localization of the inflammation, can be explained in terms of medical history . Before the introduction of imaging techniques in medicine, inflammation in the area of ​​the adnexa caused by transvaginal palpation could usually not be precisely assigned to the individual anatomical structures of the adnexa. Therefore one spoke in simplified terms of the inflammation of the appendages ( adnexitis ). The term male adnexitis is and has been used rather seldom, since the anatomical allocation of an inflammation in the genital tract is usually easier in men (e.g. prostatitis ).

Female genital tract

Female adnexitis

clinic

The patients usually complain of acute onset, laterally accentuated lower abdominal pain, postmenstrual or periovulatory . If there is accompanying inflammation in the area of ​​the cervix ( cervix uteri ) or the uterus, there is also discharge (fluorine) or spotting . In the case of severe infections, vomiting and ileus symptoms can also occur. It is not uncommon for inflammation caused by chlamydia to be accompanied by perihepatitis ( Fitz-Hugh-Curtis syndrome ). There are pain in the right upper abdomen and a slight increase in liver enzymes . Adnexitis can cause an acute abdomen .

etiology

As a rule, these are germs that ascend into the fallopian tubes via the vagina and uterus. Often there is also inflammation in the area of ​​the cervix (cervicitis) and the lining of the uterus (endometritis). This inflammation is often found shortly after menstruation or shortly after ovulation (ovulation). At this time, the mucus in the area of ​​the cervix (cervix) is softened and therefore more pervious. The maximum age is between 15 and 20 years.

Pathogen

Diagnosis

  • Clinical examination:

On palpation , uterine and adnex pressure pain and portio- push pain are found.

  • gynecological check:

During the speculum examination, inflammation of the cervix can be shown and smears can be taken for microbiological determination of the germs.

microbiological smear.

secondary inflammation

  • Measurement of body temperature

Differential diagnosis

u. a.

therapy

Since most adnexitis today are caused by chlamydia , an uncomplicated and outpatient treatable adnexitis is initially treated with tetracyclines or fluoroquinolones for at least 10 days. If therapy fails, therapy with cephalosporins and metronidazole is initiated. In the event of further therapy failure, an attempt should be made to preserve the triggering germ and a germ-specific antibiotic therapy should be started. Abscesses are usually approached and relieved in the hospital and surgically. Pain is addressed with anti-inflammatory drugs (e.g., diclofenac ).

Complications

  • Sterility : The formation of scars and structures due to adhesions can lead to obstructive sterility.
  • Adhesions and accumulation of secretions ( hydrosalpinx , hematosalpinx , pyosalpinx (saktosalpinx), dysmenorrhea )
  • abscess
    • Tubo- ovarian abscess : encapsulated inflammatory focus with involvement and caking of the fallopian tube and ovary
    • Douglas abscess : encapsulated inflammatory focus in the area between the rectum and uterus ( Douglas space )
  • Peritonitis : life-threatening breakthrough of the purulent inflammation in the free abdominal cavity
  • sepsis
  • Chronic Adnexitis: Symptoms of chronic adnexitis are often bland. Often there are pelvic discomfort and pain during sexual intercourse ( dyspareunia ). There may also be chronic discharge. It is difficult to treat therapeutically, as adhesions are often the cause of the symptoms.

Male adnexitis

The term male adnexitis includes inflammation of the prostate ( prostatitis ), the vas deferens ( funiculitis ), the testicle ( orchitis ), the epididymis ( epididymitis ) and the seminal vesicles ( spermatocystitis ). The term male adnexitis is rarely used in clinical parlance.

literature