HYDROSALPINX ( A Review )

           A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility .

           The major causes for distal tubal occlusion is Pelvic Inflammatory diseases (PID), usually as a consequence of an ascending infection by Chlamydia or gonorrhea. However, not all pelvic infections will cause distal tubal occlusion. tuberculosis is an uncommon cause of hydrosalpinx formation.

         While the ciliae of the inner lining (endosalpinx) of the fallopian tube beat towards the uterus, tubal fluid is normally discharged via the fimbriated end into the peritoneal cavity from where it is cleared. If the fimbriated end of the tube becomes agglutinated, the resulting obstruction does not allow the tubal fluid to pass; it accumulates and reverts its flow downstream, into the uterus, or production is curtailed by damage to the endosalpinx. This tube then is unable to participate in the reproductive process: sperm cannot pass, the egg is not picked up, and fertilization does not take place.

          Other causes of distal tubal occlusion include adhesion formation from surgery, endometriosis and cancer of the tube, ovary or other surrounding organs.

        A hematosalpinx is most commonly associated with an ectopic pregnancy. A pyosalpinx is typically seen in a more acute stage of PID and may be part of a tuboovarian abscess (TOA).

      Tubal phimosis refers to a situation where the tubal end is partially occluded, in this case fertility is impeded, and the risk of an ectopic pregnancy is increased.

            The Symptoms can vary. Some patients have lower often recurring abdominal pain or pelvic pain, while others may be asymptomatic. As tubal function is impeded , infertility is a common symptom. Patients who are not trying to get pregnant and have no pain, may go undetected. IUDs , endometriosis , and abdominal surgery sometimes are associated with the problem.

           As a reaction to injury, the body rushes inflammatory cells into the area, and inflammation and later healing result in loss of the fimbria and closure of the tube. These infections usually affect both fallopian tubes, and although a hydrosalpinx can be one-sided, the other tube on the opposite side is often abnormal. By the time it is detected, the tubal fluid usually is sterile, and does not contain an active infection.



SPECIMEN OF TOTAL ABDOMINAL HYSTERECTOMY WITH BILATERAL HYDROSALPINX



           Hydrosalpinx may be diagnosed using ultra sonography as the fluid filled elongated and distended tubes display their typical echolucent pattern. However, a small hydrosalpinx may be missed by sonography. During an infertility work-up a hysterosalpingogram (HSG), an X-ray procedure that uses a contrast agent to image the fallopian tubes, shows the retort-like shape of the distended tubes and the absence of spillage of the dye into the peritoneum. If, however, there is a tubal occlusion at the utero-tubal junction, a hydrosalpinx may go undetected. When a hydrosalpinx is detected by an HSG it is prudent to administer antibiotics to reduce the risk of reactivation of an inflammatory process.

         When a Laparoscopy is performed, the surgeon will note the distended tubes, identify the occlusion, and may also find associated adhesions affecting the pelvic organs. A laparoscopy not only allows for the diagnosis of hydrosalpinx, but also presents a platform for intervention .

         It is a preventable disease , as PID is the major cause of hydrosalpinx formation, steps to reduce sexually transmitted disease will reduce hydrosalpinx. Also, as hydrosalpinx is a sequel to a pelvic infection, adequate and early antibiotics treatment of a pelvic infection is called for.

          It can be managed by tubal infertility due to hydrosalpinx underwent tubal corrective surgery  to open up the distally occluded end of the tubes (salpingostomy) and remove adhesions (adhesiolysis). Unfortunately, pregnancy rates tended to be low as the infection process often had permanently damaged the tubes, and in many cases hydrosalpinges and adhesions formed again. Further, ectopic pregnancy is a typical complication. Surgical interventions can be done by laparotomy or laparoscopy.

ENDO SALPINX ON HYSTO PATOLOGICAL EXAMINATION

         Non-infertile patients who suffer from severe chronic pain due to hydrosalpinx formation that is not relieved by pain management may consider surgical removal of the affected tube(s) or even a hysterectomy with removal of the tubes, possibly ovaries.

        I will like to add that , with the advent of IVF which bypasses the need for tubal function a more successful treatment approach has become available for women who want to conceive. IVF has now become the major treatment for women with hydrosalpinx to achieve a pregnancy.

            A number of studies have shown that IVF patients with untreated hydrosalpinx have lower conception rates. It has been assumed that the tubal fluid that enters the endometrial cavity alters the local environment or affects the embroy in a detrimental way. Thus, many specialists advocate that prior to an IVF attempt, the hydrosalpinx should be removed., or the couple can be advised adoption of legitimate new born , because in our country , a couple planning for IVF , spends a lot , so as not to afford IVF.