Painful hydrosalpinx

Specialty: Gynecology and breast.

• Fluid buildup in the fallopian tube
• painful dilated tube
• distended salpinx

Why it occurs

• Sequela of Pelvic Inflammatory Disease (PID) with obstruction of the tubal fimbria
• Severe post-surgical pelvic adhesions (appendicular surgery, endometriosis)
• Tubal endometriosis that obstructs the distal lumen of the tube
• Previous tubal sterilization surgery (tubal ligation) with accumulation of retained mucus

Initial workup

Detailed transvaginal gynecological ultrasound (a thin-walled, elongated tubular structure is evident, filled with anechoic fluid, with residual papillary projections inside that simulate "cogwheels" or the "rosary bead" sign). Hysterosalpingography if baseline fertility is being studied. Pelvic MRI to differentiate it from ovarian cysts or solid masses.

Standard management

• There are no drugs that reverse tubal obstruction or established chronic hydrosalpinx. If the pain is chronic dull, NSAIDs such as Naproxen 500 mg orally every 12 hours are prescribed. If there is suspicion of infectious exacerbation (pyosalpinx), broad-spectrum antibiotic treatment is prescribed for PID (Ceftriaxone 500 mg IM single dose plus Doxycycline 100 mg every 12 hours orally for 14 days). Curative treatment in patients with persistent pain or undergoing in vitro fertilization (IVF) is surgical removal of the affected tube by laparoscopy (salpingectomy) due to the embryotoxic effect of hydrosalpinx fluid (note: simple puncture drainage is associated with very high rates of rapid recurrence).