Hydrosalpinx

Etiopathogenesis and infection pathways

The development of the inflammatory process in the uterine appendages occurs through several pathways:

• Ascending pathway — occurs most frequently. Opportunistic microflora from the vagina penetrates through the uterine cavity into the lumen of the fallopian tubes.
• Hematogenous pathway — a rare variant typical of tuberculous involvement (mycobacteria enter from the primary focus via the bloodstream).
• Descending (contact) pathway — infection spreads secondarily from inflamed abdominal organs (e.g., in acute appendicitis).
• Intraamniotic pathway — associated with invasive procedures during pregnancy (amniocentesis, cordocentesis, embryo reduction).
• Lymphogenous pathway — occurs significantly less often.

Important triggers include intrauterine manipulations (abortions, contraceptive insertion, diagnostic curettage) and childbirth. The risk increases manifold with surgical interventions: cesarean section, manual removal of the placenta, vacuum extraction of the fetus. An additional factor is decreased immunity and indiscriminate use of antibiotics, causing non-pathogenic microorganisms to transform into pathogenic ones.

Mechanism of hydrosalpinx formation

Inflammation spreads sequentially: involvement of the uterine mucosa extends to the muscular layer (endomyometritis), and in severe cases encompasses the entire wall (panmetritis). Next, the infection reaches the fallopian tube via the ascending pathway, causing salpingitis.

Inflammatory exudate begins to accumulate in the tube lumen. This provokes a pronounced adhesive process. As a result, the ampullary (fimbrial) part of the tube closes completely. Closed saccular formations are formed — saktosalpinksy (which include hydrosalpinx and pyosalpinx).

Clinical presentation and diagnostic methods

The disease is often accompanied by purulent genital discharge and chronic pelvic pain that periodically intensifies. Due to the non-specificity of symptoms, diagnosis can be difficult. The pathology must be differentiated from endometriosis, colitis, pelvic plexitis, as well as ovarian tumors and cysts.

Main research methods:

• Bimanual examination: the physician palpates an elongated mass in the adnexal region. Limited mobility of the uterine body indicates a concomitant adhesive process.
• Pelvic ultrasound: highly effective for visualizing mass lesions.
• Laparoscopy: indicated for prolonged disease course, persistent pain, and ineffectiveness of antibiotics. It allows visual assessment of hydrosalpinges and adhesions.
• Hysterosalpingography (HSG): reveals contrast accumulation in closed cavities in tuboperitoneal infertility. However, classical X-ray HSG is now used less frequently due to the high risk of errors in image interpretation.

Possible complications

If the infection pours into the pelvic cavity through the fimbrial end, pelvioperitonitis (serofibrinous or purulent) develops, which can progress to generalized peritonitis.

Upon purulent melting of the walls of a pyosalpinx and an ovarian abscess (pyovarium), a tubo-ovarian abscess is formed. The uterus, ovary, tube, pelvic wall, and intestinal loops are involved in this dense inflammatory conglomerate. As the process becomes chronic, a dense capsule forms around the abscess. Additionally, the process can spread via the lymphogenous pathway, causing parametritis.

Another specific complication of previous acute salpingo-oophoritis (predominantly of chlamydial or gonococcal etiology) is Fitz-Hugh—Curtis syndrome — the formation of adhesions between the diaphragm and the liver surface.

Class and exam questions

What else to study on this topic

• Acute endometritis: trigger factors and the role of intrauterine manipulations.
• Tubo-ovarian abscess: mechanisms of formation and involvement of adjacent organs.
• Pelvioperitonitis: classification by character of exudate and clinical presentation.
• Fitz-Hugh—Curtis syndrome as an outcome of specific salpingo-oophoritis.
• The role of hysterosalpingography in the diagnosis of tuboperitoneal infertility.

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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.