Unilateral obstruction of the tubal fimbria

Specialty: Gynecology and breast.

• Distal blockage of the fallopian tube
• obstruction of the fimbria
• tubal obstructed distally

Why it occurs

• Pelvic adhesions secondary to previous Pelvic Inflammatory Disease (PID) or appendiceal peritonitis
• Deep peritoneal endometriosis with adnexal involvement
• Previous pelvic surgery (such as resection of ovarian cysts) that generates scarring that collapses the fimbria
• Silent infection by Chlamydia trachomatis

Initial workup

Hysterosalpingography (HSG) to evaluate the patency of the tubes (stopping of contrast output is observed at the distal end of the tube and absence of contrast dispersion in the peritoneal cavity, negative Cotte test). High resolution transvaginal ultrasound. Diagnostic laparoscopy with intraoperative chromotubation (methylene blue is instilled through the cervix and observed directly under the camera if it diffuses through the fimbria).

Standard management

• There are no drugs that eliminate mechanical adhesions or unblock the obstructed tubal fimbria. If an underlying active Chlamydia infection is suspected, Doxycycline 100 mg orally every 12 hours for 14 days is prescribed to the patient and her partner. The curative treatment in women with reproductive desires is laparoscopic tubal reconstructive surgery (fimbrioplasty or salpingostomy) or direct referral to highly complex assisted reproduction techniques such as In Vitro Fertilization (IVF) (note: IVF avoids the need for patent and functional tubes).