Salpingitis : laparoscopy roles

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Richard Fleming
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1 Salpingitis : laparoscopy roles Dr AS AZUAR We need a relevant way to diagnose because Epidemiology Public health matter cases / year cases of tubal infertility - Pb linked to complications/ sequelae / cost 1

2 Clinical pictures No pathognomonic sign Many silent pictures infertility-tubal sequelae Asymptomatic in 70% cases Moderate salpingitis in 30% Severe salpingitis in 5% Many differential diagnosis Westrom, STD, 99 Criteria of diagnosis - Minimum criteria : painful palpation of uterus or adnexa - Additionnal criteria : minimum criteria specificity : anamnesis, fever, T>38.3, purulent leucorrhoea, biological inflammation - Specific criteria : frozen section, laparoscopy A a conclusion: polymorphous pictures, reliable diagnosis difficult Workowski, CDC, 2002 Bacteriological analysis Swabs : vagina, endocerix, endometrium, uretra, +/- IUD Hemocultures Serology STD Sexual partner analysis Not really contributary analysis Cohen CR,

3 Radiological diagnosis Endovaginal ultrasound: pyosalpinx, ovarian or Douglas Pouch abcess Diagnosis ( pachy salpinx ou hydrosalpinx) US contributary ++ in severe pictures Scanner-US contributary in differential diagnosis We need a reliable tool to follow up because. Evolution Spontaneous healing, with or without pelvic sequelae +++ Acute complications: pelviperitonitis, septic shock, ectopic pregnancy Chronicity: infertility, chronic pains Unpredictable 3

4 We need a reliable tool to treat because. ATB European recommendations : fluoroquinolone-metronidazole (2006) Probabilistic treatment, broad-spectrum active aerobic anaerobic Biantibiotherapy for 21 days In case of gonococcus, ceftriaxone IM (Rocéphine ) added Initial surgical assessment + ATB complications of 75% [1] [1] Judlin, 2009 So 4

5 Laparoscopy Gold standard : 3 indications formal - Diagnostic doubt (atypical, differential diagnosis) - Collection abscess on ultrasound - Persistence of signs after 2-3 days of medical treatment Limitations - Anesthetic and surgical risk Molander P, Obstet Gynecol 2003 Magnin G, 2002 Royal College of Obstetricians and Gynaecologists, 2003 Chevalier N, 2002 Sexual l y Transmi t t ed Di seases Treat ment Guidelines, 2006 Initial laparoscopy Routine for some indications : for the nulligeste, childbearing project or diagnostic doubt Controversy + + (first means less invasive than laparoscopy) Laparoscopy is opposed to the tendency of Anglo-Saxon to a systematic test tt Royal College of Obstetricians and Gynaecologists, 2003 Laparoscopy Many interests Diagnosis : positive or differential diagnosis Treatment: adhesiolysis, drainage, resection, peritoneal lavage Prognosis : assessment of the lesions and II look [1] Thejls N, 2001 [2] Sivalingam N,

Surgical treatment Inspection: Staging tubal damage, adhesions (scores) Bacteriological:(ATB before if possible) Adhesiolysis: conservative + +Drainage pelvic collections Excision of necrotic

6 Surgical treatment Inspection: Staging tubal damage, adhesions (scores) Bacteriological:(ATB before if possible) Adhesiolysis: conservative + +Drainage pelvic collections Excision of necrotic lesions, adnexectomy Peritoneal lavage: serum hot Inspection Laparoscopic semiology Forms : Stage 1: catharrale (tubal swelling, pelvic inflammatory disease) Stage 2: adhesions, pachysalpinx Stage 3: pelvic collections (pyosalpinx, abscess complex adnexal) FHC syndrome DD 6

inflammatory disease) Stage 2: adhesions, pachysalpinx Stage 3:

7 Stage I-catharrale False membranes-necrosis Laparoscopic semiology Forms : Stage 1: catharrale (tubal swelling, pelvic inflammatory disease) Stage 2: adhesions, pachysalpinx Stage 3: pelvic collections (pyosalpinx, abscess complex adnexal) FHC syndrome DD 7

2: adhesions, pachysalpinx Stage 3: pelvic collections

8 Stage II-Pachysalpinx Laparoscopic semiology Forms : Stage 1: catharrale (tubal swelling, pelvic inflammatory disease) Stage 2: adhesions, pachysalpinx Stage 3: pelvic collections (pyosalpinx, abscess complex adnexal) FHC syndrome DD Stage III-Pyosalpinx 8

Stage 2: adhesions, pachysalpinx Stage 3: pelvic

9 Stage III-Pyosalpinx Laparoscopic semiology Forms : Stage 1: catharrale (tubal swelling, pelvic inflammatory disease) Stage 2: adhesions, pachysalpinx Stage 3: pelvic collections (pyosalpinx, abscess complex adnexal) FHC syndrome DD FHC 9

pachysalpinx Stage 3: pelvic collections (pyosalpinx, abscess

10 Laparoscopic semiology Forms : Stage 1: catharrale (tubal swelling, pelvic inflammatory disease) Stage 2: adhesions, pachysalpinx Stage 3: pelvic collections (pyosalpinx, abscess complex adnexal) FHC syndrome DD Differential diagnosis Sampling 10

11 Surgical treatment Inspection: Staging tubal damage, adhesions (scores) Bacteriological:(ATB before if possible) Adhesiolysis: conservative + +Drainage pelvic collections Excision of necrotic lesions, adnexectomy Peritoneal lavage: serum hot Adhesiolysis Surgical treatment Inspection: Staging tubal damage, adhesions (scores) Bacteriological:(ATB before if possible) Adhesiolysis: conservative + +Drainage pelvic collections Excision of necrotic lesions, adnexectomy Peritoneal lavage: serum hot 11

12 Surgical treatment Excision (salpingectomy) or salpingotomy-flattening? Retrospective 60 adnexal abscesses: - 25 incisions, drainage - Salpingectomy or adnexectomy 35 Success Rate Same [1] Buchweitz O, 2000 Surgical treatment Inspection: Staging tubal damage, adhesions (scores) Bacteriological:(ATB before if possible) Adhesiolysis: conservative + +Drainage pelvic collections Excision of necrotic lesions, adnexectomy Peritoneal lavage: serum hot II look : goals 12

13 When Indications : Young patients Desire further pregnancies Severe salpingitis Residual pain [1] Tran DK, 2002 [2] G Le Bouedec, 1991 [3] Gerber, 1996 When and What for 3 to 6 months after the initial episode Actions to achieve: Adhesiolysis Tubal assessment and surgery: - distal tubal surgery for stages IVF for stages 3-4 [1] Tran DK, 2002 [2] G Le Bouedec, 1991 [3] Gerber, 1996 Indications and goals + + Interest in severe pictures Bilateral tubal occlusion treated: 10% mild salpingitis, 20% and 32% moderate-severe Adhesions were removed in 38% of cases In the absence of II look systematic interventions for infertility or pelvic pain in 11.6% [1] Tran DK, 2002 [2] G Le Bouedec, 1991 [3] Gerber,

14 INSPECTION ADHESIOLYSIS BLUE DYE TEST 14

15 BLUE DYE TEST FIMBRIOPLASTY SALPINGECTOMY vid2 15

16 CONCLUSIONS Diagnosis recovered Inspection, assessment of the lesions Potentiation-adaptation ATB Improved prognosis 16

PELVIC INFLAMMATORY DISEASE (PID) SALIM ABDUL-RAZAK (INTERN RADIOGRAPHER) TAMALE TEACHING HOSPITAL

PELVIC INFLAMMATORY DISEASE (PID) SALIM ABDUL-RAZAK (INTERN RADIOGRAPHER) TAMALE TEACHING HOSPITAL OBJECTIVES Definition of PID Prevalence rate of PID Causes of PID Symptoms of PID Risk factors Investigations