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Inflammation of the uterine appendages (salpingoophoritis, adnexitis) is very common and insidious disease. Often the disease proceeds almost unnoticed and does not threaten the woman’s life. But it is fraught with very serious consequences. The main one is the inability to have children in the future. According to statistics, every fifth woman who has suffered such inflammation suffers from infertility. Very often, due to the modern rhythm of life, a woman does not pay attention to alarming symptoms, does not consult a doctor, which contributes to the transition of the disease to chronic form. Therefore, today we will talk about inflammation of the uterine appendages, symptoms of the disease.

IN healthy body the uterine appendages (fallopian tubes and ovaries) are in a sterile state. However, under certain conditions, such as rule violations intimate hygiene, harmful microbes enter them, causing an inflammatory process. Also often the appendages are affected by sexually transmitted microorganisms. These include chlamydia, myco- and ureaplasma, gonococci, trichomonas.

IN adolescence A common gynecological disease is vulvovaginitis. It affects the external genitalia and vagina. If a teenage girl masturbates, microorganisms enter the uterine cavity. This leads to inflammation of the appendages.

There is a certain risk group for the occurrence of this disease:

* Teenage girls who started early sex life– 12-14 years;

* Young women 18-25 years old, when sexual partners often change, which provokes the development of inflammation;

* Women 28-30 years old. At this age, infection can occur as a result of childbirth, abortion, use of intrauterine devices;

* Unmarried women having multiple sexual partners.

How does the disease develop?

Viruses and harmful bacteria that enter the vagina move through the cervical canal and enter the fallopian tubes and ovaries. Subject to availability chronic diseases pyelonephritis, tonsillitis, etc., microbes enter the uterine appendages through the blood and lymphatic vessels.

Symptoms of the disease

The main feature developing disease, is a dull pain in the lower abdomen. At first it does not cause much concern, it is nagging in nature, and gradually intensifies. Then painful sensations become permanent and do not go away even at night. After about a week, the pain becomes very severe and radiates to the rectum. It becomes painful to sit, lie, and move. In this case, painkillers provide only a short-term effect, the pain returns very quickly. At the same time, body temperature often rises and dry mouth appears. The woman has a rapid heartbeat and loss of appetite. Depending on the type of infection, other symptoms may develop: painful urination, vaginal discharge mixed with pus, etc.

Signs of acute inflammatory process in the appendages similar to symptoms acute appendicitis, peritonitis. Similar symptoms observed with intestinal tumors, renal colic. Typically, signs of the disease appear 2-3 days after infection, or after hypothermia.

If these symptoms appear, you should not hesitate and consult a doctor. The longer you delay a visit to a specialist, the more complications accumulate. After all, if you naively think that everything will go away on its own, the treatment may end in operating table. Some diseases, such as salpingoophoritis, require hospital treatment. Therefore, in order to accurately determine the diagnosis of the inflammatory process, and therefore proceed to timely and proper treatment, you need to contact a gynecologist.

Consequences of inflammation of the uterine appendages

If the disease is not treated, acute form the disease will become chronic. In this case, there is a high probability of an inflammatory process occurring in neighboring organs - the uterine cavity, kidneys, and bladder.

A purulent layer may appear in the cavities of the uterine tubes and ovaries. In this case, surgical intervention and removal of these organs cannot be ruled out.
Inflammation can spread to the peritoneal area, and this can lead to peritonitis with the formation of adhesions in fallopian tubes Oh.

Failure to take measures to treat the disease leads to the spread of infection. This may result in blood poisoning (sepsis). As a result, the functioning of the entire body is disrupted, which can end very sadly. The development of ectopic pregnancy, tubal obstruction and infertility are also often observed.

Most common cause the appearance of inflammation of the fallopian tubes and ovaries is the penetration of sexually transmitted pathogens. Therefore, most effective prevention of this disease are sexual relations With permanent partner, using a condom, as well as observing the rules of intimate hygiene. It is also very important to visit a gynecologist at least 2 times a year for a preventive examination and timely detection pathogens of inflammation. Be healthy!

Acute inflammation of the uterine appendages is more common in at a young age; its frequency in recent years increased by 13% among the general population of women childbearing age and by 25% among women using intrauterine contraceptives. In 85% of patients with this pathology, the inflammatory process takes a protracted course, of which 20 - 30% require inpatient treatment. IN modern conditions The inflammatory process in the uterine appendages often occurs without pronounced clinical manifestations (" erased forms"); the typical picture of the disease is observed only in 37% of cases.
Acute inflammatory diseases of the uterine appendages can be caused by one or more pathogens; depending on the entry of the infectious agent, they can be endogenous and exogenous (after abortion, intrauterine contraception), primary (infection spreads from the lower genital tract) and secondary (infection spreads from nearby organs- for example, appendix).
Infection of the internal genital organs is possible in various ways: the introduction of microbes into the vagina through sexual intercourse, which are transmitted vector-borne diseases caused by gonococci, chlamydia, mycoplasma, viruses (the number of these diseases is approaching 20 and tends to increase); penetration of microbes into the uterus is also due to surgical interventions(curettage of the walls of the uterine cavity, hysterosalpingography, kymographic pertubation, intrauterine contraception), if asepsis is broken. In addition, microbes can enter the uterus after abortion and childbirth if there is an inflammatory process in the vagina, cervix, from the intestines (inflammatory processes in the intestines, appendicitis), from distant foci of infection (otitis media, tonsillitis).
The pathogen can also penetrate from the lower genital tract into the fallopian tubes with the help of Trichomonas, sperm, or by passive transport.

Pathogenesis. According to modern ideas, inflammatory reaction consists of cell damage, changes in vascular reactions with exudation, biological release active substances, phagocytosis, physicochemical changes in the focus of inflammation and proliferative processes. In inflammatory diseases of the female genital organs, the entire body is involved in the process, and the abundant innervation of the female genital organs often determines participation in the inflammation nervous system, which gives the disease a peculiar picture. Pathological impulses coming from the genital organs during acute inflammation cause changes functional state cerebral cortex, which, in turn, can contribute to changes in endocrine system. There is a decrease in the secretion of luteinizing hormone from the pituitary gland compared with the indicators in healthy women, the appearance of several additional peaks of luteinizing and follicle-stimulating hormones in the luteal phase. In 60 - 80% of patients, signs of ovarian hypofunction were detected. Along with neuroendocrine disorders important in the pathogenesis of inflammation there are changes in blood vessels (increased blood flow, and then dystonia, increased vascular permeability in the microcirculation system of the affected organ, which is associated with the action of histamine released from the affected tissues).
The development of the inflammatory process is also facilitated by the reduced immunological reactivity of the patient’s body. In acute inflammatory diseases, an immunological imbalance develops: the level of immunoglobulins of class G increases significantly, the level of immunoglobulins of group M decreases, the phagocytic activity of leukocytes increases, the amount of lysozyme in the blood decreases. cervical mucus, complementary activity decreases. A universal inflammatory protein appears - C-reactive protein, the determination of which can be used for diagnostic purposes.

Clinical picture. There are acute, subacute salpingoophoritis (inflammation of the fallopian tube and ovary) and chronic process in the acute stage. Acute inflammation of the uterine appendages means clinical manifestations acute process ( high temperature, disturbance of the general condition, severe intoxication, changes in the blood picture, focal disorders, pain reaction), which occur as the first episode of the disease. Subacute inflammation is also a process that has arisen for the first time, but with less pronounced clinical symptoms. Acute and subacute inflammatory processes can occur against a background of chronic ones. Thus, when the inflammatory process worsens, one should take into account the possibility of its acute and subacute course.
Inflammation of the uterine appendages is observed in 67 - 98.8% of cases simultaneously with endometritis (inflammation of the uterine mucosa). Ophoritis (inflammation of the ovary) usually develops after salpingitis (inflammation of the fallopian tube). Acute inflammation of the uterine appendages includes salpingitis (inflammation of the fallopian tube), salpingoophoritis (inflammation of the fallopian tube and ovary), pyosalpinx ( purulent inflammation fallopian tube), hydrosalpinx (inflammation of the fallopian tube with accompanying effusion), inflammatory tubo-ovarian formation, tubo-ovarian abscess (purulent inflammation of the fallopian tube and ovary).

When diagnosing acute inflammatory diseases uterine appendages, the patient’s complaints, anamnesis data, history of the present disease and gynecological examination.
Most often, patients complain of constant sharp pains in the lower abdomen (in every 2nd woman), radiating into the rectum and lumbar region. Weakness, sweating, chills, nausea, vomiting, frequent urination, purulent vaginal discharge can also be symptoms of acute inflammatory disease of the uterine appendages. Sometimes from the anamnesis it becomes known that some patients associate the disease with menstruation (41.8%), with hypothermia (23.6%), with intrauterine manipulations(12.7%), with the introduction of intrauterine devices (7.2%), with hysterosalpingography (1.8%); a number of women indicate that the disease arose after the onset of sexual activity or after a change of sexual partner.
At general examination the patient's condition is assessed as relatively satisfactory or moderate. In 33% of patients the temperature was elevated to 38°C, in the rest it was normal. There is an increase in heart rate to 100 - 110 per minute. Palpation of the abdomen is sharply painful in lower sections, muscles of the anterior abdominal wall tense.

Treatment. When identifying acute inflammation uterine appendages in patients, the patient should be hospitalized in a hospital.

Prevention of inflammatory diseases of the uterine appendages should start at childhood. Great value have preventive examinations girls and girls. Timely diagnosis and treatment of inflammatory diseases in girls and young women help reduce the incidence of gynecological morbidity in women reproductive age. Important role plays a role in carrying out health education work among women (discussion possible consequences extramarital sex, harm from abortion, personal hygiene, selection of contraceptive methods).

What antibiotics should I take for inflammation of the appendages? This frequently asked question. Let's look at it in more detail.

The uterine appendages are the ovaries and fallopian tubes located on both sides of the pelvis. Infectious agents usually enter the appendages from the vagina or uterus. The inflammation process is most often caused by staphylococcus, chlamydia or gonococcus. Separate inflammation of a tube or one ovary is very rare. As a rule, the inflammatory process immediately affects both the tubes and the ovaries.

Treatment of inflammation of the appendages should be timely.

Causes of inflammation

Oophoritis is called inflammation of the ovaries, which is often combined with salpingitis. In medicine, salpingitis refers to inflammation of the fallopian tubes. The cause of the disease can be various microorganisms, which, as a rule, occur in combination. Such microorganisms are very resistant to antibiotics. The inflammatory-changed fallopian tubes fuse with the ovary, forming an entire inflamed formation. The appearance of pus in the fallopian tubes leads to the destruction of ovarian tissue.

How does inflammation of the appendages manifest itself in women?

Symptoms

Acute inflammation can manifest itself as pain in the lower abdomen and lumbar region. A high temperature may also occur along with chills and impaired urination. The first signs of inflammation of the appendages are not difficult to recognize.

On chronic stage patients are bothered by pain in the lower abdomen, their menstrual cycle is disrupted, discharge from the genital tract is observed, and in case of exacerbation, deterioration may occur general well-being. If pus breaks through into the abdominal cavity, a serious complication may occur in the form of inflammation of the peritoneum, which in medicine is called pelvioperitonitis. Most severe complication formation of adhesions in abdominal cavity, and as a result, infertility occurs.

What is the treatment for inflammation of the appendages?

Therapy methods

Patients with acute illness are often prescribed inpatient treatment. At the same time, it is recommended for women bed rest. Patients take antibiotics for one week. Preferably drugs from the penicillin or tetracycline group are prescribed. If treatment with one specific antibiotic is ineffective, the doctor may prescribe another, so antibiotic therapy may be delayed as a result.

Injections are also often prescribed for inflammation of the appendages. Patients are injected with solutions that relieve intoxication in the body. Anti-inflammatory drugs, for example Diclofenac, are also prescribed orally in the form of injections, tablets or rectally. If necessary, prescribe antifungal and antihistamines medicines. Taking vitamin complexes is also very important.

Treatment of inflammation of the appendages is determined depending on the causative agents of the disease. In the presence of an acute process, rest is necessary. It is advisable to apply ice to the lower abdomen. Painkillers are also used along with antimicrobials. At the same time, doctors prescribe restorative and physical therapy to patients. In the event that drug therapy turns out to be unsuccessful, doctors resort to surgical treatment.

To date, reliable methods have been developed for the treatment of inflammation of the appendages, which include a course of injections of the antibiotic “Gentamicin” into the ovaries. Anti-inflammatory vaginal tampons are also used, along with injections into the ovary of an enzyme called Lidase, which can dissolve adhesions.

Treatment with drugs

The main method of therapy for this disease is to prescribe antibiotics to patients. Their choice is determined by the properties of the infectious agent and its sensitivity to the selected antibiotic.

It is very important that the dosage of antimicrobial tablets for inflammation of the appendages fully ensures their maximum concentration in areas of inflammation. Thus, antibiotics with a longer half-life are used to treat inflammation. At heavy currents A variety of antibiotic combinations are used. In case of inflammation caused by pathogens such as streptococcus, along with staphylococcus and enterobacteria, treatment begins with the prescription of penicillin. In this case, aminoglycosides are also prescribed in parallel. Drugs for the treatment of inflammation of the appendages can be purchased at any pharmacy.

If the presence of anaerobic flora is suspected, Metronidazole is used; in advanced cases, it is prescribed intravenously. In less difficult situations enough of him oral administration. Also prescribed antihistamines like "Suprastin" and "Diphenhydramine". This is done in order to avoid intoxication.

As prescribed by a gynecologist, at the first signs of inflammation of the appendages, they can be prescribed the following drugs:

Medicines in the form of “Sumamed”, “Urotropin” and “Garamycin”.
Doxycycline-based drugs are often prescribed, for example, Doxibene along with Doxinate, Medomycin, and Unidox.
Preparations based on clindamycin in the form of “Dalacin”, “Klimitsin”, “Clindafer”, “Clindacin” and “Klinoxin”.
Medicines based on metronidazole in the form of “Klion”, “Trichopol” and “Flagyl”.
It can also be prescribed in the form of “Nevigramon”, “Negram” or “Ofloxacin”.
Medicines based on ceftriaxone, for example, Megion along with Oframax, Rocephin and Cefaxone.
Medicines based on ciprofloxacin, for example, drugs such as Aquacipro along with Arflox, Afenoxin, Ificipro, Quintor, Liproquin, Medociprin, Microflox, Proxacin and "Ciprinol."
Vitamin medications in the form of Redoxone, Celascon, Rutin, and so on.
Painkillers based on acetylsalicylic acid, for example, “Asalgin” along with “Aspilite”, “Aspirin” and “Fortalgin”.

What will help in case chronic inflammation appendages?

Treatment with candles

For quick removal symptoms of inflammation are usually used local remedies in the form of candles. Their action:

antiseptic;
antimicrobial;
regenerating;
anti-inflammatory;
pain reliever;
immunomodulatory.

Vaginal suppositories for inflammation of the appendages are very effective. Such therapy is carried out, as a rule, for anti-inflammatory purposes and is prescribed in addition to the main therapy. For this purpose, suppositories with propolis are used, and in addition, with extract walnut. But it should be emphasized that it is impossible to get rid of inflammation of the appendages only with anti-inflammatory suppositories. If a woman has chronic inflammation, she is recommended to undergo treatment with suppositories for preventive purposes, especially if she is prone to thrush. Let's look at the most effective ones:

"Movalis", "Voltaren" - relieve pain and have an anti-inflammatory effect, the symptoms of inflammation are eliminated for 8-12 hours. Some vascular diseases and bleeding disorders are contraindications.
"Hexicon", "Flowmizin", "Chlorhexidine" are good antiseptics in the form of candles vaginal use. The effect is on the source of infection, the mucous membrane is disinfected.
"Betadine", "Poliginax", "Terzhinan" - they are used to treat inflammation that arose due to the colonization of pathogenic microflora.

Home therapy methods

The following recipe is suitable for the treatment of chronic inflammation of the appendages. You need to boil the leaves of half a head of fresh cabbage in a liter of milk. Next, pour the contents into a suitable vessel and sit on it, taking a steam bath. This procedure should be repeated until the inflammation stops.

If the appendages are inflamed, you should also drink juice on an empty stomach, which is obtained from one whole raw potatoes average size. Before drinking, the resulting juice should be well stir so that the settled starch can become suspended. The drug is taken until the symptoms are relieved.

Douching

The question of the effectiveness of douching for adnexitis and salpingitis is open today. Medicinal herbs when used in this way, they can penetrate directly into the place that is affected by the pathogen and have an impact on it. However pathogenic flora vagina spreads into the uterus. This is fraught with the occurrence of additional infection. A woman should consult a specialist before undergoing vaginal irrigation.

Alcohol-containing products are not used for douching. The syringe must be treated in advance. If the instrument is not sterile, the mucous membranes of the vagina may become inflamed. This is an extra portion pathogenic microorganisms And additional risk complications.

Tampons

There are many ways to treat ovarian inflammation at home. The use of tampons is considered very effective. With this method, there is no risk of spreading infection, unlike douching, and you can safely use it yourself. It is important to choose the most effective ingredients for the medicine, since all substances have an individual effect.

Tampons are often made from medicines in the form of ointments such as "Levomekoli" and "Methyluracil". They are applied to sterile gauze and inserted into the vagina. It is important to understand that only a freshly prepared tampon is used. The course of therapy with such compresses lasts up to two weeks, this is influenced by the clinical manifestations of the disease.

Traditional therapy

To directly relieve pain from inflammation of the appendages, it is recommended to use the following recipes:

A decoction of bergenia rhizomes is effective. To do this, pour 10 grams of rhizomes with a glass of boiling water. Next, the product is boiled for about half an hour in a water bath and filtered. Use the resulting product for daily douching twice a day.
Nettle juice is good for treating appendages. To prepare the medicine, one spoon of the juice of this plant must be dissolved in a quarter glass of water. This dosage is drunk three times a day twenty minutes before meals.
A decoction of St. John's wort also helps. To obtain the medicine, pour a glass of boiling water over a spoonful of herbs and boil over low heat for fifteen minutes, then filter. They drink the medicine for a week, a quarter glass three times a day. Against the background of inflammation of the appendages in women, herbs are a great help.
Pour two tablespoons of goose cinquefoil with a glass of boiling water and leave for exactly an hour. Drink the medicine on an empty stomach, half a glass before each meal, four times a day. At night, douche from a more concentrated tincture; to prepare it, pour five tablespoons of the herb with a liter of boiling water and leave for one night in a thermos.

Treatment folk remedies inflammation of the appendages in women can be very effective, but it should be carried out under the supervision of a doctor, taking into account individual reaction.

To treat inflammation in folk medicine There are a lot of different recipes:

A spoon of dried, and at the same time crushed, is poured with a glass of boiling water. Next, the product is infused for about four hours, after which it can be used a quarter glass twice a day.
If you have problems with the appendages, the juice of aloe leaves helps, which is taken orally in a spoon three times a day before meals.
Raw pumpkin passed through a meat grinder, and the juice is squeezed out of the pulp. The resulting juice should be consumed in large quantities in case of inflammation of the appendages.
Pour a glass of boiling water over a spoonful of blueberry leaves and leave for half an hour, then filter. The resulting product is used for daily douching in the morning and evening as an astringent, antiseptic and anti-inflammatory agent.
Two spoons of linden flowers are poured into three glasses of boiling water. The resulting medicine is used orally, half a glass three times a day.
Barberry helps a lot. To prepare the medicine, pour half a spoonful of dry roots into a glass of water, then boil for half an hour. Next, the product is filtered and taken in a spoon three times a day.
It is recommended for inflammation of the appendages and lemon balm infusion, half a glass three times a day. To prepare it, take four tablespoons of dry grass and pour a glass of boiling water over it, then leave for exactly an hour and filter.
Clary flowers can also be used for inflammation of the appendages. They can be taken orally as a decoction three times a day, half a glass, or for douching. To prepare an infusion for internal use, you need to take two spoons of herbs and pour them with a liter of boiling water, and then leave. In case of external use, the amount of herb is doubled.
A spoonful of yarrow is poured into a glass of boiling water, after which it is boiled for about ten minutes. You need to drink half a glass of medicine twice a day.

Complications

If this disease is not overcome in time, it can become chronic. This form of inflammation is usually manifested by aching pain. They usually occur in the lower abdomen and are accompanied by discomfort during sex. Often, sick women experience problems with the menstrual cycle, which is accompanied by the absence of menstruation for a long time. In addition, periods may be scanty or extremely painful. The chronic form of inflammation of the appendages can lead to the following extreme adverse consequences:

The appearance of an ectopic pregnancy.
Spontaneous abortions.
The development of tubal obstruction along with problems with ovulation, as a result of which doctors may diagnose infertility.
The appearance of adhesions.
Spread of infection to neighboring organs, for example, the intestines or bladder, due to which inflammation can also develop in them.

neglected state acute stage inflammation may result in the development of one of the extreme dangerous complications requiring immediate surgical intervention, we're talking about about peritonitis and purulent melting of the tubes, and, in addition, the ovaries of the uterus.

Disease prognosis

A woman can expect a favorable prognosis against the background of inflammation of the appendages only if she promptly consults a gynecologist at the first symptoms of the disease. It is very important that no complications arise during treatment. For example, immediately after the transfer chronic adnexitis, and, in addition, as a result of some acute severe forms diseases (gonorrheal type or tuberculosis), in fifty percent of cases women experience infertility. In addition, with a chronic form of inflammation, other problems arise associated with spontaneous abortions, ectopic pregnancy and so on.

In order not to think about how to relieve inflammation of the appendages at home in the future, it is necessary to carry out preventive measures. Chronic adnexitis has a tendency to worsen. At the slightest decrease immunity, all symptoms of inflammation return. This means that even a common cold can worsen a woman’s condition.

In order to prevent possible exacerbation disease, you should adhere to the following several rules:

Have only one sexual partner, excluding any casual ones intimate relationships.
Try to avoid attack unwanted pregnancy, and, in addition, abortions.
Try to avoid hypothermia and stress.
Go to an appointment with a gynecologist every six months, regularly taking smears.

It must be said that inflammation of the ovaries and fallopian tubes is currently a very common problem, but this pathology can be successfully and quickly treated, so the main thing is to consult a doctor in a timely manner. It is also important to correctly identify the causes of inflammation of the appendages.

Inflammation of the uterine appendages occupies a leading position among all gynecological diseases. The inflammatory process, which was treated inadequately and untimely, threatens with a number of complications and consequences, including transition to a chronic form. It is known that about 20% of women who have suffered adnexitis become infertile.

Inflammation of the uterine appendages: what is it? The uterine appendages include the fallopian tubes, ovaries and ligaments. Inflammation of the appendages is called adnexitis or salpingoophoritis. There are acute and chronic adnexitis. Also, the inflammatory process can develop both on one side - unilateral salpingoophoritis, and on both sides - bilateral adnexitis. In this article we will describe the causes, symptoms and treatment of inflammation of the uterine appendages.

Causes of inflammation of the appendages

The causative agent of the inflammatory process in the uterine appendages are pathogenic and opportunistic microorganisms, which under certain factors become pathogenic. There are specific adnexitis caused by gonococci, tuberculosis bacillus and diphtheria bacteria and nonspecific salpingoophoritis (chlamydia, mycoplasma, staphylococcus, streptococcus, coli, fungi, viruses and other microorganisms). Often the disease is caused by an association of microorganisms.

Infection in the uterine appendages can enter in different ways:

Factors contributing to the development of the disease:

promiscuous sex life;
failure to comply with intimate hygiene rules;
stress, hypothermia;
intrauterine procedures - ), curettage of the uterine cavity, removal and insertion of the IUD, metrosalpingography, ;
complicated childbirth;
weakening protective forces body - HIV infection, diabetes mellitus, recent infectious disease;
appendectomy.

Symptoms of adnexitis

Acute adnexitis

The clinical picture of acute salpingoophoritis is very typical. The disease begins acutely, with an increase in temperature (up to 38 - 39 degrees), with suppuration of the appendages, chills appear. There are sharp, sharp pains in the lower abdomen. Depending on whether the process is unilateral or bilateral, pain is localized in both or one iliac region. The pain radiates to the rectum, to sacral region, can radiate to the lower limb.

At the onset of the disease, palpation of the anterior abdominal wall reveals tension (a symptom of muscle protection), severe pain, and symptoms of peritoneal irritation. Signs of urination disorder (painful and frequent) may appear. Suffering general condition sick: appears headache, there is no appetite, nausea and vomiting occur.

At gynecological examination Serous-purulent or purulent discharge from the cervical canal is observed. The area of the appendages is painful when palpated; it is difficult to clearly determine their size and contours; the appendages are pasty, enlarged, and their mobility is limited. IN general analysis blood is determined by leukocytosis, acceleration of ESR. The level of C-reactive protein also increases in the blood.

Chronic adnexitis

Chronicization of the process occurs with poor quality treatment of acute inflammation of the uterine appendages or in the absence of therapy at all. The clinical picture of chronic salpingoophoritis is erased, the disease proceeds with periodic exacerbations(usually in spring and autumn). Pain syndrome is characteristic, and its severity does not correspond to changes in the appendages. Symptoms of inflammation of the appendages chronic — dull pain, aching, localized in the lower abdomen, radiating to the lower back and vagina. Palpation of the abdomen is moderately painful.

The menstrual cycle is disrupted, resulting in polymenorrhea ( heavy menstruation), oligomenorrhea (rare, short periods, see), algomenorrhea ( painful menstruation, cm. ). associated with structural and functional changes in the ovaries (hypoestrogenism, lack of ovulation).

Sick women may also complain of decreased or absent sexual desire and pain during intercourse (dyspareunia). With the long-term existence of chronic adnexitis, the digestive (colitis), urinary (pyelonephritis), endocrine and nervous (neurosis, depression) systems suffer. The ability to work of such patients is reduced, and conflicts are common in the family.

When the process worsens, the temperature rises to low-grade levels (not higher than 38 degrees), and the pain intensifies. During gynecological examination mucopurulent discharge from the cervical canal, in the area of the appendages, heaviness (sclerotic changes), their pain on palpation, limitation of their mobility and pain when the uterus is displaced behind the cervix (due to the development adhesive process).

Complications of adnexitis

Salpingoophoritis is dangerous due to the following complications:

transition to a chronic form;
- due to the development of adhesions, anovulation;
increases ;
development purulent complication– tubo-ovarian formation (purulent melting of the tube and ovary with the formation of an abscess).

Case study:

For the first time in my practice I encountered a tubo-ovarian formation in the second month independent work. A young woman was admitted at night with signs of peritoneal irritation (pelvioperitonitis), severe intoxication syndrome and severe pain lower abdomen. Preliminary diagnosis: Acute adnexitis complicated by tubo-ovarian formation, acute pelvioperitonitis. According to the rules, it is necessary to treat for 2 hours (to relieve intoxication and pain intravenous infusions solutions with antibiotics), and then urgently operate. After 2 hours, I called the surgeon on duty (the hospital is small, there are few doctors), who was my classmate, and we went for the operation. When they cut my stomach, I almost grabbed my head. Adhesions all around, massive purulent effusion in the abdomen, appendages on one side are not visualized at all, but only some kind of conglomerate of supposed appendages, omentum, thick and small intestine. The young surgeon and I began to determine what was what and how to cut it off. But, in the end, we performed the operation, albeit within 2.5 hours. They removed what was needed, washed the stomach and drained it. Subsequently, the woman was found to have gonorrhea. I must say that the operation was indeed difficult, and not everyone experienced doctor will take on this. Subsequently, I operated on a lot of tubo-ovarian abscesses, but, fortunately, I never encountered such advanced cases.

Treatment of salpingoophoritis

Treatment of inflammation of the appendages is carried out in a hospital and begins with a diet with limited salt, pepper and carbohydrates and a regimen (in bed in the first days).
In case of acute adnexitis and exacerbation of chronic adnexitis, patients are prescribed cold on the lower abdomen (relieves inflammation and pain).

The main point in the treatment of inflammation is antibiotics. Antibiotics are selected from wide range actions and maximum period half-life Since the disease is often caused by communities of microorganisms, 2 or more drugs are used in antibiotic therapy:

klaforan 1.0 – 0.5 g. 2 times a day IM and gentamicin 80 mg 3 times a day IM;
cephobid 1.0 g. 2 times a day IM in combination with gentamicin;
clindamycin 2.0 g. twice a day in combination with gentamicin;
cefazolin 1.0 g. 2 times a day IM and ciprofloxacin 100.0 ml 2 times a day IV;
lincomycin 0.6 g. 3 times a day IM;

It is mandatory to prescribe metronidazole 500 mg 3 times a day orally or metrogyl 100.0 ml 2 times a day intravenously (if an anaerobic infection is suspected).

In addition, detoxification therapy is carried out (intravenous infusions saline solutions, glucose, hemodez, rheopolyglucin and others in a volume of 2 - 3 liters).
For cupping pain syndrome and to reduce signs of inflammation, non-steroidal anti-inflammatory drugs are prescribed in tablets, see list (Ibuklin, Nurofen, Faspik), ketorolac (Ketanov, Ketarol), etc. and rectal suppositories(paracetamol, indomethacin, diclofenac, see).
Vitamins are also used (vitamin C, group B)
Antihistamines (suprastin, pipolfen, and others).

When relieving an acute process and in the treatment of chronic inflammation of the appendages outside of exacerbation, physiotherapy is widely used: electrophoresis of copper and zinc in phases menstrual cycle, ultrasound, impulse currents high frequency (SMT, DDT). Also in rehabilitation treatment They use immunomodulators, autohemotherapy, injections of aloe, FIBS, Longidase, etc. For chronic adnexitis it is indicated spa treatment- dirt, paraffin, medicinal baths and douching (see).