出血性输卵管炎12例误诊分析

出血性输卵管炎１２例误诊分析胡炳真郭盛菊（慈溪市人民医院）出血性输卵管炎（ｈｅｍｏｒｒｈａｇｉｃｓａｌｐｉｎｇｉｔｉｓ）是一种特殊类型的输卵管炎症，临床易误诊为宫外孕。１９９２年１月至１９９６年１月我院有１２例出血性输卵管炎误诊为宫外孕，现分析如下。...     

出血性输卵管炎致急腹症13例临床分析

出血性输卵管炎致急腹症１３例临床分析叶玲玲，陈红舟（浙江省舟山市人民医院）出血性输卵管炎（ＨｅｍｏｒｒｈａｇｉｅＳａｌｐｉｎｇｉｔｉｓ）是妇科急腹症之一，因临床表现为腹痛、内出血，酷似宫外孕，故常误诊。１９９１年１月至１９９３年１２月我院经手术及病理...     

出血性输卵管炎21例分析

出血性输卵管炎是妇科急腹症之一.由于其具有隐匿性的特点,术前常常容易误诊,甚至在术中也不易认识到,往往直到病理学检查结果出来才确诊该病.本文对我院2000年1月至2005年12月收治的共21例出血性输卵管炎进行回顾性分析,旨在提高对本病的认识,减少误诊,避免不必要的手术.     

妇科急症399例临床分析

目的 :回顾性分析 399例妇科急症的诊断和鉴别诊断。方法 :对我院自 1995年 4月 30日至 2 0 0 0年 4月 30日间收治的 399例妇科急症手术进行回顾性分析。其中有腹腔内出血的 381例。结果 :通过了解病史、症状、体征和 B超检查 ,异位妊娠和卵巢囊肿蒂扭转的术前和病理诊断符合率 10 0 %。2 9例卵巢破裂中有 10例术前误诊为异位妊娠 ,误诊率34 .5 %。 8例出血性输卵管炎 ,误诊为异位妊娠 5例 ,卵巢破裂 3例 ,误诊率 10 0 %。结论 :有待于提高卵巢破裂和出血性输卵管炎的临床诊断率 ,尤其对出血性输卵管炎的认识。而异位妊娠的早期诊断和卵巢囊肿蒂扭转前的积极处理应该受到重视     

出血性输卵管炎52例分析

出血性输卵管炎５２例分析徐永莉（５５７２００贵州省榕江县医院）出血性输卵管炎是输卵管间质层出血，血液突破粘膜上皮进入管腔，由伞端流入腹腔，引起输卵管及腹腔积血，而出现剧烈腹痛的一种急腹症，临床上并不罕见。现将我院１９７３年１月至１９９３年１２月２０年...     

宫内早孕合并出血性输卵管炎2例

出血性输卵管炎是妇科临床少见的一种疾病，同时合并有宫内早孕就更为罕见，极易误诊。现将我们近期诊治的２例报告如下。例１２４岁，以“停经３６天，突发下腹痛２小时”为主诉于１９９８年９月１６日急诊入院。平素月经规律，末次月经１９９８年８月９日，经量正常，...     

经血倒流腹腔致急腹症病例临床分析

目的 探讨经血倒流腹腔致急腹症的病因及临床特征，提高对本病的认识，减少误诊。方法 对经血倒流腹腔致急腹症的3个病例资料进行回顾性分析。结果 经血倒流腹腔致急腹症的临床表现与黄体破裂、出血性输卵管炎、异位妊娠极为相似，不易鉴别，本资料中3例有2例误诊为黄体破裂，误诊率高。结论 经血倒流致急腹症与近期有宫腔操作史或子宫过度后倾后屈有关，可表现急性腹痛和少量腹腔内出血，很少引起休克。可保守治疗。     

出血性输卵管炎腹腔大出血1例

出血性输卵管炎腹腔大出血１例黎之明，陈新景（５２４００１湛江市广东医学院附属医院）患者，３８岁。７年前人工流产后上环，月经周期３０～４５天，末次月经于１９９１年１２月２５日。１９９２年２月８日开始阴道出血，如月经量，无组织物排出。２月９日下午６时开始...     

出血性输卵管炎36例分析

出血性输卵管炎３６例分析熊小娟，周慧珍，吴瑞岚出血性输卵管炎是因输卵管粘膜血管扩张、瘀血、肿胀，细小血管自发破裂出血，血液流入腹腔，引起剧烈腹痛和腹腔内出血为主要症状的一种急腹症，国内外报道不多￣［１－４］。现将我院收治的３６例报告如下。一、临床资料...     

出血性输卵管炎合并子宫肌瘤1例

出血性输卵管炎是急性输卵管炎的一种特殊类型，此病少见，但合并子宫肌瘤更少见。我院收治1例，现报告如下。     

Laparoscopic findings and contraceptive use in women with signs and symptoms suggestive of acute salpingitis

Laparoscopic findings in women with clinical signs and symptoms of pelvic inflammatory disease were correlated with contraceptive use in a case-control study. Of the 738 women, 544 (73.7%) had laparoscopic signs of acute salpingitis, whereas 194 (26.3%) had visually normal fallopian tubes (nonsalpingitis). Acute salpingitis was seen in 59.8% of the 286 patients using oral contraceptives, in 80.6% of the 227 patients using an intrauterine device (IUD), and in 84.4% of the 225 patients using barrier methods or not using contraceptives (reference group). To estimate the relative risk of acute salpingitis, logistic regression analysis adjusting for age and duration of pain before laparoscopy was used. For oral contraceptive users versus the reference group the adjusted relative risk was estimated at 0.24 (95% confidence interval 0.15 to 0.38, P less than .0001), and for IUD users versus the reference group a relative risk was estimated at 0.83 (95% confidence interval 0.49 to 1.38, P = .46). The relative risk of salpingitis among oral contraceptive users versus the reference group was 0.22 (P = .005), and 0.06 (P = .001) for women infected with Chlamydia trachomatis and/or Neisseria gonorrhoeae, respectively. In patients with pelvic inflammatory disease, spread of the inflammation to the fallopian tubes seems to be inhibited in oral contraceptive users.     

Acute chlamydial salpingitis with ascites and adnexal mass simulating a malignant neoplasm.

Chlamydia trachomatis is a well-known cause of acute and chronic salpingitis, accounting for approximately half of all cases of pelvic inflammatory disease. Typically, patients with acute chlamydial salpingitis present with acute lower abdominal pain, tenderness on bimanual pelvic examination, or vaginal discharge. We describe a case of acute chlamydial salpingitis with marked ascites and an adnexal mass that simulated a malignant neoplasm. Microscopically, a severe lymphofollicular salpingitis and a marked lymphofollicular hyperplasia of the omentum and retroperitoneal lymph nodes were found. Chlamydial inclusions in the fallopian tube epithelium were demonstrated by immunohistochemistry using a mouse monoclonal antibody to a genus-specific outer membrane lipoprotein. Chlamydial infection may cause marked ascites and a palpable adenexal mass and should be considered whenever marked chronic inflammation with a lymphofollicular hyperplasia involves the fallopian tube or other female genital tract sites.     

Laparoscopy in women with chlamydial infection and pelvic pain: a comparison of patients with and without salpingitis

A review was made of clinical and laboratory findings in 104 women who, during 1978 to 1981, were subjected to laparoscopy because of symptoms suggestive of acute salpingitis, and who harbored Chlamydia trachomatis but not Neisseria gonorrhoeae in the genital tract. The patients with acute salpingitis (N = 76) did not differ significantly from those with visually normal fallopian tubes (N = 28) in regard to age distribution, parity, contraceptive method used, proportion of women with urethritis symptoms, increased vaginal discharge, vomiting, diarrhea, elevated rectal temperature, elevated white blood cell count, and palpable pelvic masses. The acute salpingitis patients more often had irregular bleeding and an elevated erythrocyte sedimentation rate, whereas the patients without acute salpingitis more often had a short history of pelvic pain. The two groups overlapped considerably with respect to the number of symptoms and clinical signs of pelvic infection. The results emphasize the value of laparoscopy in the diagnosis or exclusion of a tubal infection in association with a chlamydial genital infection and pelvic pain, even if there are comparatively few additional symptoms of ascending infection.     

The frequency of salpingitis and ectopic pregnancy as epidemiologic markers of Chlamydia trachomatis

BACKGROUND: To study the incidence of non-gonococcal salpingitis, gonococcal salpingitis and ectopic pregnancy in a defined population over a 28-year period on the assumption that the frequency of salpingitis and ectopic pregnancy may indirectly illustrate the epidemiological pattern of Chlamydia trachomatis. DESIGN: A retrospective epidemiological study. SETTING: University hospital with an urban catchment area. PATIENTS: Five thousand two hundred and thirty-three patients admitted to the hospital between 1969 and 1996 with a diagnosis of ectopic pregnancy, non-gonococcal salpingitis, or gonococcal salpingitis. RESULTS: The frequencies of both non-gonococcal and gonococcal salpingitis increased steeply early in the period under study, rising to a peak in the early 1970s, then decreasing throughout the period except for the last 3 years when a slight increase was seen again. The frequency of ectopic pregnancy showed a steady increase, peaking in the late 1980s and early 1990s and then declining at the end of the study period. While the introduction of more sensitive pregnancy tests and programs for assisted fertility would increase the rate of ectopic frequency the decline during the 'nineties cannot be accounted for in this way. The peak of salpingitis cases in the early 'seventies seems to be mirrored exactly by the peak of ectopic pregnancies fifteen years later in the late 'eighties. CONCLUSION: The frequencies of salpingitis and of ectopic pregnancy can probably be used to estimate the incidence of preceding Chlamydia trachomatis. Thus the incidence of C. trachomatis has probably declined since the early 'seventies like that of N. gonorrheae.     

Clinical utility of CA125 levels in predicting laparoscopically confirmed salpingitis in patients with clinically diagnosed pelvic inflammatory disease.

OBJECTIVE: The purpose of this study was to determine the utility of serum CA125 determinations in diagnosing acute salpingitis. METHODS: CA125 levels were determined for 34 women with the clinical diagnosis of pelvic inflammatory disease (PID). Acute salpingitis was confirmed laparoscopically in 28 women (82.3%). RESULTS: Twenty patients (71.4%) with laparoscopically confirmed acute salpingitis had CA125 levels greater than 7.5 units, compared with no patients (0/6) with laparoscopically normal tubes (P = 0.002). The degree of elevation of CA125 levels correlated with the severity of tubal inflammation noted at laparoscopy. All patients with levels above 16 units had laparoscopically severe salpingitis. CONCLUSIONS: We conclude that while CA125 levels above 7.5 units may modestly improve the ability of the clinical diagnosis of PID to accurately reflect visually confirmed acute salpingitis, limitations of the test make its clinical utility questionable.     

Etiology of acute salpingitis: influence of episode number and duration of symptoms

The role of Neisseria gonorrhoeae in the etiology and pathogenesis of acute salpingitis and its relationship to nongonococcal salpingitis were investigated. To accomplish this goal, isolated microorganisms obtained from the fallopian tubes and cul-de-sac via laparoscopy were evaluated in relation to the number of episodes of salpingitis, duration of symptoms, and phase of menstrual cycle at infection onset. The incidence of isolation of N gonorrhoeae was inversely proportional to the number of episodes of salpingitis. No isolation of the gonococcus occurred from patients with 3 or more previous episodes of salpingitis. N gonorrhoeae was the most frequent organism recovered within the initial 24 hours of symptoms. Beyond 48 hours, the most frequent isolates were anaerobic bacteria, especially anaerobic cocci. Anaerobic bacteria were also recovered from the fallopian tubes in patients having their initial episode of salpingitis and within 24 hours of onset of symptoms. All fallopian tube isolates of gonococci were recovered within 7 days of the onset of menses.     

Increased inducibility of inflammatory mediators from peripheral blood mononuclear cells of women with salpingitis

To investigate whether immune system activation may contribute to the tissue damage observed in salpingitis, we isolated peripheral blood mononuclear cells and quantitated production of the monocyte activation products tumor necrosis factor-alpha, interleukin-1, and interleukin-6. Unstimulated cells from 7 of 20 women with salpingitis spontaneously released tumor necrosis factor at a concentration greater than 2 SD above the mean value produced by cells from 29 healthy donors. Interferon gamma (200 U/ml) further induced production of tumor necrosis factor from mononuclear cells of 11 women with salpingitis. In contrast, production of tumor necrosis factor by each of 23 other patients who lacked laparoscopic or clinical evidence of salpingitis was similar to that of the controls. In a subset of women whose cells were tested for production of other monokines, three of nine women with salpingitis spontaneously released interleukin-1 but none of the others did so. Four of nine patients with salpingitis also produced interleukin-6, but none of the others did so. None of the monokines were detected in serum from any subject. The results suggest that monocytes from women with salpingitis are primed in vivo and produce inflammatory mediators under conditions where monocytes from other women are poorly responsive. This increased monokine inducibility may contribute to the tubal damage that is the hallmark of salpingitis.     

Viable intrauterine pregnancy with acute salpingitis progressing to septic abortion. A case report

BACKGROUND: A viable intrauterine pregnancy with salpingitis has been reported rarely. CASE: A 27-year-old woman at 10 weeks' gestation developed abdominal pain, fever, leukocytosis, peritoneal signs, closed cervix and a viable pregnancy. Progression from acute salpingitis to septic abortion was documented. CONCLUSION: Acute salpingitis in the presence of a viable pregnancy warrants aggressive intervention.     

Serologic evidence of prior chlamydial infection in patients with tubal ectopic pregnancy and contralateral tubal disease

Oviductal damage from infectious salpingitis is a principle cause of ectopic pregnancy. To examine the role of Chlamydia trachomatis in patients with ectopic pregnancy, 24 patients undergoing laparotomy for ectopic pregnancy were evaluated by assessment of chlamydial serology and chlamydial cultures of tubal biopsy specimens. The patients were divided into two groups based on the presence or absence of gross abnormalities in the fallopian tube contralateral to the ectopic gestation. Ten patients in group I showed gross evidence of chronic salpingitis in the contralateral tube; 14 patients in group II had normal-appearing contralateral tubes. Chlamydial cultures were negative in both groups. Chlamydial immunoglobulin M antibodies assayed by indirect microimmunofluorescence were negative in both groups (less than or equal to 1:32). Mean geometric immunoglobulin G titers for C. trachomatis were significantly higher in the patients with evidence of contralateral chronic salpingitis (78.9 versus 13.1). These findings suggest that C. trachomatis may be a major cause of oviductal damage, which predisposes to ectopic pregnancy.     

High hepatitis B carrier rate among non-Oriental patients with acute salpingitis

Hepatitis B surface antigen screening was performed on non-Oriental patients with the diagnosis of acute salpingitis. Six of 59 (10.17%) had hepatitis B surface antigenemia. We therefore recommend hepatitis B screening for all patients with salpingitis. The detection of covert hepatitis B helps to protect hospital staff and provides important information for the patient. Further, the administration of hepatitis B vaccine may be appropriate for those patients with acute salpingitis who are found to be hepatitis B surface antigen-negative.