Cemile DAYANGAN SAYAN, Zehra Sema ÖZKAN, MAHMUT İLKİN YERAL, Funda ERDOĞAN, Zeynep İSLAMBAY

YENİ SEKSÜEL AKTİF KADINDA DEV HİDROSALPENKS

Pelvik inflamatuvar hastalık, endometrit, parametrit, ooforit, tubo-ovaryan abse ve/veya peritoniti kapsayan üst genital yollarının inflamasyonu olarak tanımlanır. Pelvik inflamatuar hastalık çoğunlukla alt genital trakttan asendan yolla gelen enfeksiyonlardan kaynaklanır. Reproduktif çağda olan ve rahim içi araç kullanan kadınlar pelvik inflamatuvar hastalık açısından yüksek risk taşırlar. Bu çalışmada yeni seksüel aktif genç kadında dev hidrosalpenks olgusu sunuldu.Yeni seksüel aktif (4 ay), 23 yaşında kadın hasta jinekoloji polikliniğimize karın ağrısı, ateş ve halsizlik şikâyetleri ile başvurdu. Ateşi 38.7 oC olarak ölçüldü. Jinekolojik muayenede eksternal genital organlar normal, serviks nullipar görünümde idi ve gri-kahverengi kokulu akıntı izlendi. Transvajinal ultrasonografide sağ adneksiyel alanda 91x29 mm boyutunda hidrosalpenks görünümü izlendi. Hasta hastaneye yatırılarak 14 gün süre ile parenteral geniş spektrumlu antibiyotik tedavisi verildi. Taburculuk sonrası oral antibiyotik tedavisine devam edildi. Oral antibiyotik tedavisinin 2. hafta ve 1. ay kontrollerinde hidrosalpenks görünümü sırası ile 48x9 mm ve 30x8 mm boyutlarına geriledi.Reproduktif çağdaki kadınları etkileyen pelvik inflamatuvar hastalık seksüel aktivitenin başlamasından kısa bir süre sonra ortaya çıkabilir ve erken dönemde ciddi komplikasyonlara sebep olabilir. Bu nedenle seksüel aktivitesi yeni başlamış genç yaş kadınların seksüel geçişli hastalıklar hakkında bilgilendirilmesi gereklidir.

Anahtar Kelimeler:

Hidrosalpenks, pelvik inflamatuar hastalık, salpenjit

Huge Hydro-Pyosalpinx in a Recently Sexually Active Woman

Pelvic inflammatory disease is defined as the inflammation of the upper genital tract. Its spectrum includes endometritis, parametritis, oophoritis, tubo-ovarian abscess and sometimes even peritonitis. Pelvic inflammatory disease is most often caused by infection from the subgenital tract. Reproductive women with intrauterine devices are at high risk for pelvic inflammatory disease. In this study, we presented a giant hydrosalpinx in a newly sexually active young woman.A 23-years old woman with new-onset sexual intercourse (4 months), admitted to our gynecology out-patient clinic with complaints of abdominal pain, fever and fatique. She was suffering from pelvic pain and aberrant vaginal discharge for two days. Her body temperature was 38.7oC. Her gynecological examination findings were as follows: normal external genitalia, nulliparous external os with green-brown and heavy discharge. Evaluation with transvaginal ultrasonography showed 91x29mm hydro-pyosalpinx on the right adnex. Parenteral broad-spectrum antibiotic was given for 14 days. The patient was discharged with oral antibiotherapy. At two weeks and one month controls after cessation of oral antibiotherapy, the size of hydrosalpinx decreased to 48x9 mm and 30x8 mm respectively.Pelvic inflammatory disease affecting reproductive age women may develop shortly after the onset of sexual activity and may cause serious complications in the early period. For this reason, younger women who have newly started sexual activity need to be informed about sexually transmitted diseases.

Keywords:

hydrosalpinx, pelvic inflammatory disease, salpingitis,

PDF

___

Workowski KA, Berman S. Centers for disease control prevention, sexually transmitted diseases treatment guidelines, MMWR Recommendations and Reports. 2010;59:1-110.
Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clinical Gynecology and Obstetrics. 1993;36:433-44.
Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. American Journal of Obstetrics and Gynecology. 2002;186:929-37.
Kisa O, Baysallar B, Hakbilen S, Albay A, Gun H. Evaluation of the risk of developing bacterial pelvic inflammatory disease in pregnant women prior the endometrial curettage. Etlik Clin J. 1997;10:115-8.
Ross J. Pelvic inflammatory disease. Br Med J. 2001;322:658-9.
Boukaidi SA, Delotte J, Steyaert H, Valla JS, Sattonet C, Bouaziz J, et al Thirteen cases of isolated tubal torsions associated with hydrosalpinx in children and adolescents, proposal for conservative management: retrospective review and literature survey. J Pediatr Surg. 2011;46:1425-31.
Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod. 1999;14:1243.
Kawwass JF, Crawford S, Kissin DM, Session D, Boulet S, Jamieson DJ. Tubal factor infertility and perinatal risk after assisted reproductive technology. Obstet Gynecol. 2013;121(6):1263.
Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Salpingectomy for hydrosalpinx prior to in vitro fertilization. Fertil Steril. 2008; 90: S66.
Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BW. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2010:(1):CD002125.
Farid H, Lau TC, Karmon AE, Styer AK. Clinical Characteristics Associated with Antibiotic Treatment Failure for Tuboovarian Abscesses. Infect Dis Obstet Gynecol. 2016;2016:5120293.
Kazmi Z, Gupta S, Dobson M. Suggested spontaneous resolution of possible paediatric hydrosalpinx: a case report with discussion. Gynecol Surg. 2016;13:43-8.
Ness RB, Randall H, Richter HE, Peipert JF, Montagno A, Soper DE, et al. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health. 2004;94(8):1327.