A Text-book of Diseases of Women

by Charles B. Penrose

Closure of the abdominal ostium by any method is to be viewed as a conservative process. It prevents leakage, through this channel, of septic material, and consequently diminishes the danger of peritonitis.

Fig. 147.—Salpingitis with partial inversion of the fimbriæ.

When the abdominal ostium has become closed, the tubal contents and secretions may have a sufficient passage for escape by the isthmus into the uterus, and no further changes take place beyond slow infiltration and degeneration of the tube-walls. The tube may become much hypertrophied, not from distention of the lumen, but as the result of simple inflammatory infiltration of the mucous and muscular coats, and may attain the size of the thumb. The walls may become much degenerated, soft, and friable, so that the tube may easily be cut through by a ligature or may be broken by bending.

The whole tube may become much elongated and very tortuous, reaching a length of six or eight inches. The isthmus of the tube, or the portion in immediate relation to the uterus, is usually least affected. The whole tube may become much hypertrophied, and yet the isthmus will remain approximately of its normal size. In other cases, however, the disease extends throughout the whole length of the tube into the uterine horn, and the degeneration of the tube may be such that it may readily be broken off at its junction with the uterus.

If, after the ostium abdominale has been closed, anything occurs to obstruct the escape of the tubal contents into the uterus, cystic distention of the tube will take place. Such obstruction may be produced by swelling of the mucous membrane in the narrow isthmus; by cicatricial contraction; or by a sharp flexure in any part of the tortuous tube. Sometimes there are two or more distended portions of the same tube.

When the tube is distended with pus, the condition is called a pyosalpinx; when distended with a watery fluid, a hydrosalpinx; and when distended with blood, a hematosalpinx.

Tubal cysts of this kind may attain large size, in some cases equal to that of the fetal head.

The shape of the tube becomes much altered. The greatest distention is at the distal portion, so that the tube assumes a pear-shape. The lower portion of the tube is restrained by the mesosalpinx and the tubo-ovarian ligament, so that as the tube increases in length the upper portion appears to outgrow the lower, and a retort-shaped tumor results, or the tube may become tortuous and folded upon itself.

As the tube enlarges the layers of the mesosalpinx may become separated, and the tube burrows between them until it is brought into immediate contact with the ovary, and the retort-shaped tumor appears with the ovary lying in the concave portion.