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Inflammation of the uterine appendages (salpingoophoritis)
Medical expert of the article
Last reviewed: 07.07.2025
Salpingo-oophoritis - inflammation of the uterine appendages - is the most common inflammatory disease of the internal genital organs (70%). The relative rarity of isolated forms of inflammation of the uterine appendages (salpingitis and, especially, oophoritis) is explained by anatomical proximity and common blood and lymph circulation.
Inflammation of the uterine appendages is more common in women of reproductive age. The occurrence of salpingo-oophoritis is facilitated by (menstruation, abortions, childbirth, curettage of the uterus, intrauterine contraceptives, violation of personal hygiene and hygiene of sexual life.
The development of the inflammatory process in the fallopian tube always begins with the mucous membrane of the tube, then affecting other layers. Further spread, the form of the disease, and the features of the clinical course depend on the virulence of the pathogen and the state of the body's defenses.
Acute salpingitis is accompanied by the accumulation of liquid inflammatory exudate in the lumen of the fallopian tube, which, pouring into the abdominal cavity, often causes an adhesion process around the uterine appendages. Inflammation in the ampullar and intramural (uterine) sections can lead to obstruction of the tube. Continued exudation is accompanied by the accumulation of serous fluid in the cavity of the tube, its significant increase and the formation of sactosalpinx. When infected, the contents of the tube suppurate and pyosalpinx occurs. Further progression of the disease can lead to the spread of infection beyond the primary focus (tube) and involvement in the inflammation of the uterus (endometritis), fiber (parametritis) and peritoneum (pelvioperitonitis) of the small pelvis. Generalized forms of septic infection may occur. Pyosalpinx may open with pus flowing into the abdominal cavity or adjacent hollow organs (intestine, urinary bladder, vagina). The ovary may also be involved in the conglomerate of tissues and organs formed around the pyosalpinx. In such cases, a common purulent "sac" occurs - a tubo-ovarian abscess (adnextumor, tubo-ovarian inflammatory tumor).
The cessation of the inflammatory process of the uterine appendages and the recovery of the patient is often incomplete. The disease often takes a chronic form, which is characterized by a recurrent, exacerbated course. More and more often, erased and primarily chronic forms of inflammation of the uterine appendages are noted (about 60%).
In inflammatory diseases of the female genital organs, the lesion is most often localized in the uterine appendages. According to observations concerning patients hospitalized in the gynecological department of the emergency hospital, acute adnexitis was diagnosed in 76.1% of cases of acute inflammatory processes of the upper parts of the genital apparatus, and in 81.5% of cases the process was bilateral. From 42.8% to 75.9% of cases, the inflammatory process in the appendages is combined with endometritis.
A wide range of microorganisms act as pathogens of the disease. Quite often, the cause of acute salpingitis is gonococcus: these figures fluctuate within 16-23.8%. It is necessary to take into account that in modern conditions, gonococcus can cause an inflammatory process in association with other flora, for example, with chlamydia, or create conditions for the invasion of other microorganisms into the tubes, including non-spore-forming anaerobes.
Chlamydia, mycoplasma, various representatives of aerobic flora (staphylococci, E. coli, Proteus, enterococci, Klebsiella, etc.) can serve as an etiological factor in the development of acute inflammation of the appendages, acting in isolation or in association with each other, and in the latter cases the disease is much more severe. Anaerobes (bacteroids, peptococci, pepto-streptococci, etc.), playing an important role in the development of acute salpingitis, are most often a secondary infection, leading to a sharp deterioration in the clinical picture of the disease.
In the pathogenesis of acute inflammation of the appendages, the ascending route of infection is of primary importance. Predisposing factors are menstruation, use of an intrauterine device, various transcervical diagnostic and therapeutic interventions, and termination of pregnancy. The inflammatory process begins with endosalpingitis, then the submucosal layer, muscular and serous membranes are successively involved. Serous inflammatory exudate accumulates in the lumen of the tube, which may become purulent as the process progresses. With adhesion of the uterine and ampullar ends of the tubes, a saccular formation (hydrosalpinx or pyosalpinx) is formed.
Clinical experience and morphological research data indicate that the ovaries are less often involved in the acute inflammatory process. If oophoritis occurs, it is usually secondary, i.e. a consequence of the spread of infection from neighboring organs and tissues (fallopian tube, appendix, sigmoid colon, pelvic peritoneum). First of all, acute perio-oophoritis develops, in which the integumentary epithelium is affected; after ovulation, the cortex is involved in the inflammatory process. An abscess may form at the site of a ruptured follicle or in the corpus luteum, and with complete melting of the ovarian tissue - pyovarium. If there is an abscess in the ovary, in some cases the surrounding tissue is destroyed and a single cavity with pyosalpinx is formed - tubo-ovarian abscess. It is designated by the term "purulent inflammatory formation of the uterine appendages".
[ Symptoms of acute inflammation of the appendages
Symptoms of acute inflammation of the appendages have a pronounced picture
Symptoms of inflammation of the uterine appendages are determined by the etiology, degree and stage of the disease, the reactivity of the patient's body. Acute salpingo-oophoritis is characterized by severe pain in the lower abdomen, especially on the side of inflammation, and an increase in body temperature. As the inflammatory process increases, the patient's condition worsens, symptoms of intoxication appear, pain intensifies and can become cramping, the temperature becomes high and is accompanied by chills, and symptoms of peritoneal irritation can be positive.
In the chronic stage of the process, the pain becomes dull and intermittent, intensifying during menstruation and physical exertion, after hypothermia. Nervous system disorders occur, and work capacity decreases.
The most severe cases of adnexitis are those caused by anaerobic infections, especially in association with E. coli and staphylococcus. Less pronounced symptoms and a more protracted course are characteristic of inflammatory processes caused by chlamydial infections and mycoplasmas.
Inflammation of the uterine appendages (salpingo-oophoritis) - Symptoms
Diagnosis of inflammation of the uterine appendages (salpingo-oophoritis)
Diagnosis of acute appendage damage is based on anamnesis data, characteristics of the course, results of clinical, laboratory and instrumental research methods.
When studying the patient's medical history, attention should be paid to the characteristics of sexual life, previous transcervical diagnostic and/or therapeutic interventions, termination of pregnancy, genital surgeries, the presence and duration of use of an intrauterine device. It is necessary to identify a possible connection between the onset of the disease and the menstrual cycle: the rise of infection to the desquamation phase. If there are diseases with similar clinical manifestations in the medical history, clarify the duration of its course, the nature and effectiveness of therapy, predisposing factors (hypothermia, fatigue, etc.), the presence of menstrual cycle disorders and infertility.
Inflammation of the uterine appendages (salpingo-oophoritis) - Diagnostics
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Treatment of inflammation of the uterine appendages (salpingo-oophoritis)
Treatment of acute inflammation of the uterine appendages should be performed only in a hospital setting. This rule also applies to patients with an acute course of the process without obvious clinical manifestations. The sooner the patient is hospitalized, the more timely adequate therapy will be started and the greater the chances for reducing the number of possible adverse effects characteristic of this type of disease. Attempts to treat patients in an outpatient setting, according to our observations, almost 3 times increase the percentage of such immediate and remote complications as the spread of the inflammatory process and the formation of purulent foci in the small pelvis, chronicity of the disease, disruption of menstrual and reproductive functions, and the development of ectopic pregnancy.
Patients need physical and mental rest. Depending on the characteristics of the disease, bed rest is prescribed for 3-5-7 days. Spicy dishes are excluded from the diet. Women with acute inflammatory diseases of the internal genital organs, especially with a recurrent course of the chronic process, are characterized by various psychoemotional disorders (sleep disorders, appetite, increased irritability, rapid fatigue, etc.). Therefore, it is advisable to involve a psychotherapist in the treatment of patients, prescribe sedatives, sleeping pills.
Inflammation of the uterine appendages (salpingo-oophoritis) - Treatment