A Text-book of Diseases of Women

by Charles B. Penrose

Treatment.—The treatment of acute salpingitis in its early stage should be expectant: absolute rest in the recumbent position, vaginal douches of a gallon of hot sterile water (100°-110° F.) two or three times a day, small doses of saline purgatives (Rochelle salts, ʒss-ʒj every one or two hours) until mild purgation is produced, should be prescribed, and should be continued as required. Relief of pain is afforded by hot fomentations over the lower abdomen. It is best to administer no opium, as it is very important to watch these cases closely, and the symptoms that demand operation might be masked by the administration of an anodyne. Examinations should be made with great care and gentleness, and no oftener than is necessary to determine the progress of the disease. If the patient is progressing satisfactorily, repeated examinations are contraindicated.

A chill followed by a rapid high elevation of temperature (105°-106° F.) is often caused by even gentle manipulation of the upper organs of generation in cases of acute inflammation.

The case must be watched carefully and continuously. In the gonorrheal and septic forms of the disease there is great danger of extension to the peritoneum, or of the formation of a tubal or other form of pelvic abscess that will imperil the life of the woman.

As a general rule, it may be said that, unless there are well-marked symptoms of extensive pelvic peritonitis, or unless a distinct tumor can be felt in the pelvis, operation is not indicated. As resolution undoubtedly takes place even after severe acute attacks of salpingitis, it is right to treat the woman with this end in view rather than to resort to an immediate mutilating operation.

If, under the expectant plan of treatment, the patient does not improve; if the area of pelvic tenderness increases; if the local tympany (which may at first be present only on one or both sides of the pelvis, and which indicates merely local peritoneal irritation or inflammation) extends upward; if the temperature and pulse-rate increase; if constipation appears; if, in fact, indications of extension of the peritonitis are present,—celiotomy should be immediately performed. The diseased tube or tubes should be removed, and, if necessary, the abdomen should be drained.

Fatal peritonitis sometimes results within three or four days after the onset of acute salpingitis. As soon, therefore, as the physician realizes the imminence of this complication in any case, he should not delay in removing the source of infection.

The other acute termination of salpingitis, the formation of an abscess in the pelvis, likewise demands operative interference. This condition is readily recognized. The woman has one or more chills. The temperature becomes more elevated and the pulse more rapid. The pelvic tenderness and pain may become more distinctly localized to one or both ovarian regions. Defecation and urination increase the pain. Bimanual examination reveals an exceedingly tender mass, either indurated or perhaps soft and fluctuating, lying to either side of, or behind the uterus. The character, upon palpation, of the mass depends upon the nature and extent of the peritoneal adhesions that surround it. The diagnosis of a pelvic abscess resulting from acute salpingitis is usually easy.

There is some difference of opinion among operators in regard to the best treatment for this condition. Some advise evacuation of the abscess by way of the vagina; others advise celiotomy, with removal of the abscess and the Fallopian tube that caused it, followed, if necessary, by abdominal or vaginal drainage. I prefer the latter method of treatment, for reasons that will appear under the consideration of the technique of operation.

Treatment of Chronic Salpingitis.—Cases of simple chronic catarrhal salpingitis undoubtedly recover after the cure of the endometrial disease of which the salpingitis forms a part. The tube may be restored perfectly to its normal condition; or there may remain an atrophic condition of the mucous membrane; or the fimbriæ may be left somewhat distorted, crumpled, or slightly drawn within the tube; or there may be a few fine peritoneal adhesions, like cobwebs, between the distal end of the tube, the broad ligament, and the ovary. Such slight lesions may cause no trouble beyond interfering a little with the fecundity of the woman.

When, however, the adhesions are more extensive, treatment for their relief may be demanded, even though all inflammatory action has disappeared from the body of the uterus and the tubes. Treatment in such cases is demanded, not to cure the salpingitis or on account of any danger that threatens the woman’s life, but to relieve the pain caused by the results of the inflammation.