Pathology: • Pyogenic • Gonococcal
Acute pyogenic: - The pathological changes in the tubes depend on the virulence of the organisms and the resistance of the host. There is intense hyperemia with dilated vessels visible under the peritoneal coat. The enlargement of the tube is greater than gonococcal infection because of interstitial involvement. The wall is enormously thickened and edematous. The mucopurulent or purulent exudate can be expressed out through the abdominal ostium. Microscopically, the epithelium looks normal or the mucosa slightly edematous. The muscularis shows marked edema and acute inflammatory reaction. As the outer coat is involved, adhesions are likely and are dense. If the infection is very severe, the endosalpinx is destroyed in part or whole and pus is formed. If the fimbrial end is open, the pus escapes out to cause pelvic peritonitis and abscess. The organisms may be present for even a year and as such chances of repeated infections are more.
Acute gonococcal: Like pyogenic infection, there is hyperemia and the tube is swollen and edematous. As the pathology is principally endosalpingitis, adhesions are less and flimsy.
The purulent exudate may escape in the peritoneal cavity and produces pelvic peritonitis and pelvic abscess. The ovaries may be involved in the process. More often, the fimbriae get edematous, phymotic with closure of the abdominal ostium. The uterine opening is closed by congestion. The exudate is pent up inside the lumen producing pyosalpinx. The pus becomes sterile by 6 weeks and become hydrosalpinx.
CLINICAL DIAGNOSTIC CRITERIA FOR ACUTE SALPINGITIS: -
- Abdominal tenderness.
- Rebound tenderness (±).
- Cervical and uterine motion tenderness.
- Adnexal tenderness.
- Temperature (> 38°C).
- Leucocytosis (> 10,000/mm3).
- Purulent material from peritoneal cavity by
- laparoscopy or by culdocentesis.
- Pelvic abscess or tubo-ovarian mass on bimanual examination or on sonography.
COMPLICATIONS OF ACUTE SALPINGITIS:
(i) Pelvic or generalized peritonitis
(ii) Pelvis cellulitis
(iii) Pelvic thrombophlebitis
(iv) Pelvic abscess
(v) Tubo-ovarian abscess.
FATE OF ACUTE SALPINGITIS: -
Complete resolution: Provided the tissue destruction is not appreciable, the tube returns to its normal structure and function. But endosalpingitis too often produces loss of cilia which is responsible for infertility or delay in transport of the fertilized ovum, resulting in ectopic pregnancy (10%).
Chronic: The infection may be chronic due to reinfection or flaring up of the infection at the site. Recurrent acute PID is observed in about 25% cases.
HOMOEOPATHIC MANAGEMENT OF SALPINGITIS: -
Homoeopathy is highly effective in cases of Salpingitis to reduce the inflammation of Fallopian tubes.
Merc Sol: - When there is yellowish or greenish vaginal discharge. The discharge tends to get worse after periods in most cases where merc sol is indicated. The discharge is acrid in nature causing itching and smarting/biting pain in the genitals. Itching worsens from contact of urine.
Kreosotum: - For offensive vaginal discharges. Helpful in cases of Salpingitis when putrid, offensive, vaginal discharges are present. The discharge may be white or yellow and causes itching. It tends to get worse during standing and walking and there is an increased desire to urinate frequently.
Sepia: - An excellent medicine to manage the complaints of painful intercourse in cases of Salpingitis. The pain is very intense. Along with pain, yellowish colored, foetid lumpy vaginal discharges may be present. The discharges are more during the daytime.
Colocynthis:- A prominent remedy for treating pain during menses in Salpingitis. The pain is crampy, colicky in nature, the abdomen is distended and the pain gets worse by eating or drinking.
Silicea:- Useful for managing complaints of spotting between periods. There may be attending vaginal discharges that are profuse, yellow colored and of excoriating nature.
Pulsatilla:- Helpful for Salpingitis when back pain attends Leucorrhoea. There is thick cream like vaginal discharges that are burning in nature.