Tubal Disease

Types of tubual disease

Infective

  • Pelvic inflammatory disorder (chlamydia, gonoeehoea, others)
  • Transperitoneal spread - appendicitis, intra-abdominal abscess
  • Following procedure - IUCD insertion, hysteroscopy, HSG

Non-infective

  • Endometriosis
  • Surgical - sterilisation, ectopic pregnancies
  • Fibroids
  • Polpys
  • Congenital
  • Salpingitis isthmica nodosa

Pelvic inflammatory disorder

  • Can cause hydrosalpinx: Fallopian tube is blocked and fills with serous or clear fluid near the ovary

Clinical presentation

  • Abdominal/pelvic pain
  • Febrile
  • Vaginal discharge
  • Dyspareunia
  • Cervical excitation
  • Dysmenorrhoea
  • Infertility
  • Ectopic pregnancy

Endometriosis

  • The presence of endometrial glands outside the uterine cavity

Aetiology

  • Retrograde menstruation is most likely cause
  • Some evidence for altered immune function, abnormal cellular adhesion molecules, genetics

Clinical presentation

  • Asymptomatic
  • Dysmenorrhoea (classically before menstruation)
  • Dysparenuria
  • Menorrhagia
  • Painful defaecation
  • Chronic pelvic pain
  • Infertility

Investigations

  • US scan
    • Uterus may be fixed and retroverted
    • Scan may show characteristic 'chocolate' cysts on ovary