A Text-book of Diseases of Women

by Charles B. Penrose

Fig. 151.—Chronic salpingitis: both Fallopian tubes are closed and adherent.

Rupture into the peritoneum is not the only danger to which the woman is exposed in salpingitis. The gradually formed adhesions in the pelvis impede the motion of the pelvic intestines and may cause intestinal obstruction. Obstruction of the ureters has occurred from pelvic inflammation. The Fallopian tube may discharge its contents through the bladder and produce violent cystitis, or it may discharge through the rectum or intestine, or adhere to the side of the vagina and discharge through this channel; or it may be evacuated through the abdominal parietes. Such fistulous openings rarely, if ever, close spontaneously and permanently. Temporary closure may occur, but the tube will refill and discharge as before.

Fistulæ of this kind persist for many years, becoming seats of tuberculosis or exhausting the woman by the continuous suppuration.

If the patient escape these dangers, the disease may become quiescent. Some of the less dangerous forms of salpingitis are produced, until finally, when the woman has reached middle life, a hydrosalpinx remains, or an adherent, atrophied, cord-like remnant of the tube. Though then freed from the various dangers that had threatened her life, she is not restored to health, but remains a suffering invalid.

Salpingitis may be unilateral or bilateral. It is more likely to be unilateral in the acute cases than in the chronic, for, as the primary focus of the disease exists in the body of the uterus, it will extend in time to the second tube in case only one had at first been involved. If the endometrial disease is cured before the second tube has been attacked, the salpingitis may remain unilateral. Double salpingitis is especially likely to occur in those diseases of the endometrium that are difficult or impossible to eradicate—diseases like chronic gonorrhea, where the infection lurks in the distal ends of the utricular glands and defies our methods of treatment. Operators have repeatedly removed a unilateral pyosalpinx, leaving the second tube apparently perfectly healthy, and yet, after the lapse of a few months, a second operation has been necessary for the relief of a similar pyosalpinx on the other side.

Symptoms of Acute and Chronic Salpingitis.—The symptoms of acute salpingitis are usually obscured by the accompanying symptoms of endometritis, ovarian congestion and inflammation, and localized peritonitis. The woman complains of pelvic pain and tenderness, which are most severe in one or both ovarian regions. There are elevation of temperature and rapid pulse. The knees are often drawn up as in peritonitis.

Bimanual examination reveals marked tenderness upon pressure in the vaginal fornices. There is an indistinct sense of fulness in the region of the tubes. If the pelvic peritoneum and cellular tissue are involved, the whole vaginal vault will feel full and resistant. The tissues lying to the sides and behind the uterus are thickened and resistant. If the woman is thin and there is not much surrounding inflammation, it is sometimes possible to palpate the enlarged tender tube between the vaginal finger and the abdominal hand. Usually, however, the tenderness is too great to permit this. The tube, from its increase in weight, may fall below its normal level, and may be felt lying behind the uterus in Douglas’s pouch.

Usually, in cases of acute salpingitis, the examiner is obliged to content himself with the determination of an indistinct fulness and marked tenderness in the region of the Fallopian tubes.

Before the true pathology of salpingitis was known these cases were described as pelvic peritonitis or pelvic cellulitis. It was supposed that the inflammation involved the peritoneum of the pelvis or the cellular tissue of the broad ligaments. It is true that this is often the case, and that inflammation of these structures accompanies the salpingitis, but it is the tubal inflammation which is the primary disease.