Oxiuriasis tubárica como causa de dolor abdominal en estudio: reporte de un caso / Fallopian tube as a likely cause of abdomal pain in study: case report

INTRODUCCIÓN: La oxiuriasis es una parasitosis causada por Enterobius vermicularis, cuyo ciclo vital es exclusivo en humano. En chile se subestima su prevalencia, debido a su baja notificación, sin embargo es causante de múltiples entidades clínicas como trastornos del sueño, lesiones de la mucosa nasal, vulvovaginitis,salpingitis, ooforitis, enfermedad inflamatoria pélvica, e incluso peritonitis secundaria a perforación de asa intestinal infestada. PRESENTACIÓN DEL CASO: Mujer de 33 años que ingresa al servicio de urgencia del Hospital El Pino, Santiago de Chile, con manifestaciones clínicas compatibles con apendicitis aguda. Se realiza apendicectomía y como hallazgo operatorio se constata tumor de bordes mal definidos en trompa uterina derecha, interpretado como embarazo ectópico, por lo que se realiza salpingectomía unilateral. Sin embargo, en el estudio anatomopatológico posterior se diagnostica enterobiasis tubárica DISCUSIÓN: La infestación por Enterobius vermicularis es considerada endémica en nuestro país, con una prevalencia de hasta un 41por ciento, por lo que es necesario incorporarlo como diagnóstico diferencial de abdomen agudo.

INTRODUCTION: Estrongyloides is a parasitic disease caused by Enterobius vermicularis, Humans are hosts only to this parasite. In Chile, there are an underestimated prevalence due to its low notification, however, it causes many clinical entities as sleep disorder, nasal mucosal damage, vulvovaginitis, salpingitis, oophoritis, pelvic inflammatory disease and even peritonitis due to rupture of infested intestinal loop. CASE REPORT: A 33 years old admitted to the emergency department of Hospital El Pino with clinical manifestations compatible with acute appendicitis. Appendectomy was performed, operative findings suggested an ill-defined tumor in fallopian tube, interpreted as ectopic pregnancy. Then underwent unilateral salpingectomy after pathological examination fallopian tube salpingeal was diagnosed. DISCUSSION: Given the high prevalence and the fact that mimic acute appendicitis it´s a significant part of the differential diagnosis for acute abdomen.

Evaluation of an indirect immunofluorescence assay for detecting Chlamydia trachomatis as a method for diagnosing tubal factor infertility in Mexican women.

UNLABELLED: To evaluate the clinical impact of the use of an indirect immunofluorescence assay (IFA) against Chlamydia as a method to identify patients with tubal factor infertility (TFI) in a population of infertile Mexican women. METHODS: This was a retrospective analysis made on 100 patients attending the infertility clinic who underwent laparoscopy. Blood and cervical samples were collected during the clinical examination. The presence of anti-Chlamydia trachomatis IgG antibodies was documented using the IFA test, and the presence of active chlamydial infection was evaluated using the nucleic acid hybridization assay. RESULTS: The sensitivity and specificity values of the IFA test to identify patients with periadnexal adhesions were 45% and 82%, respectively; and the positive predictive and negative predictive values were 42% and 84%, and the positive and negative likelihood ratios were 2.5 and 0.7, respectively. CONCLUSION: The IFA test was not usable for the identification of patients with periadnexal adhesions as a cause of infertility in this population. However, it could be useful as a screening test to decide which patients might receive laparoscopic treatment. Furthermore, it could be useful for identifying patients with active chlamydial infections in the upper genital tract, but a study with a larger sample needs to be done.

Salpingitis due to Entamoeba histolytica.

We describe the pathology of a unique case of Fallopian tube amebiasis, associated with hydrosalpinx, in a 21-year-old woman. She complained of lower abdominal pain, had a foul-smelling green vaginal discharge and fever during one week. There was a discrete increase in body temperature and a painful abdominal palpation at the lower right side, with signs of local peritoneal irritation. Pathological examination showed a marked dilatation of the fallopian tube and hydrosalpinx. Microscopic examination showed a poorly formed granuloma composed of large macrophages with many Entamoeba histolytica trophozoites inside the fallopian tube. Even though it is a rare disease the correct diagnosis of female genital tract amebiasis is of great importance for the indication of proper therapy.

Salpingitis tuberculosa: informe de un caso / Tuberculous salpingitis: case report

La incidencia de tuberculosis ha aumentado en los últimos años por diversos factores, entre ellos la pandemia del SIDA, las migraciones poblacionales, el deterioro de las condiciones económicas, etc. La tuberculosis genital es una entidad de curso insidioso e indolente que se manifiesta principalmente con infertilidad, amenorrea, sangrado uterino anormal y/o masa pélvica. El diagnóstico definitivo se hace a través de cultivo de flujo menstrual o biopsia endometrial para Mycobacterium tuberculosis. Debido a que esta afección es infrecuente, en la mayoría de los casos el diagnóstico se realiza posterior a una laparotomía realizada por otra causa. Se analiza el caso de una paciente asintomática de 40 años, portadora de una esterilidad primaria y sometida a cirugía por un hidrosalpinx bilateral. El diagnóstico final fue una salpingitis tuberculosa. Palabras claves: Tuberculosis genital femenina, infertilidad, masa pélvica, Antígeno Ca-125

[Emergency laparoscopy. A 20-year experience]. / Laparoscopia de urgencia. Experiencia de 20 años.

We revised 7988 laparoscopies over twenty years. Three hundred and ninety three were urgent laparoscopies: 325 patients with acute spontaneous abdomen and 68 acute traumatic abdomen. Emergency laparoscopy is made in patients with, both spontaneous and traumatic acute abdomen, when diagnosis is not made in 8 hours with the usual clinical and imaging methods. Acute diffuse peritonitis was the commonest finding in the first group (21%) and splenic rupture in the traumatic group (34%). There were two severe complications (0.5%): pulmonary oedema in a patient with myocardial disease and a respiratory failure in a old patient, which were resolved. We had two deaths related to laparoscopic diagnosis: massive mesenteric thrombosis and fecal peritonitis. There are few contraindications and tolerance is very good. This study shows a sensitivity of 98%, a specificity of 90%, a predictive positive value greater than 98% and a negative predictive value of 100%. In summary, the present study demonstrates that emergency laparoscopy is a effective diagnostic method in acute abdominal pain of uncertain aetiology.

[Clinical and microbiological study of acute pelvic inflammatory disease]. / Estudio clínico y microbiológico de la enfermedad inflamatoria pélvica aguda.

Upper genital tract infection was investigated in 46 women admitted to hospital with clinic diagnosis of acute pelvic inflammatory disease (PID) and 62 control women accepted to hospital for laparoscopy Fallopian tubes sterilization. Diagnosis was ratified by laparoscopy in mild and moderate salpingitis; culdocentesis and ultrasonography were performed in severe salpingitis and endometrial sample was made in endometritis. Microbiological specimens were taken from the cervix and abdomen. Antecedents and complete clinical studies were obtained. Patients were treated with antibiotic association sodic G penicillin, chloramphenicol and gentamicin. Risk factors to development PID were: single female (p < 0.05), multiple sexual partner (p < 0.01), previous PID (p < 0.05), infertility (p < 0.05), mean year of IUD use in severe salpingitis (p = 0.05) and mean years of age from women with sexually transmitted bacterias (STB) vs endogenous bacterias (EB) (p < 0.05). In the control group no abdomen bacterias were isolated. In patients with PID, C. trachomatis was detected by serology in 28.3%. N. gonorrhoeae was isolated from the cervix in 23.9% and from the abdomen 17.4%. Besides it was isolated from the abdomen: M. hominis 17.3% and E. coli 15.2%. STB were isolated in 54.3% and EB in 47.8% of the patients. Bacterial association was present on the 37%. Cervix isolation of G. vaginalis and Mycoplasma were not correlated with development of PID. Cervix microbiological samples were useful to know abdomen microbic etiology. They coincide with those in the 90.9%. EB were more frequently isolated from severe salpingitis (p = 0.05) and STB from mild and moderate salpingitis (p = 0.05). Antibiotic association cured all the mild and moderate salpingitis with independence of bacterial etiology. Failure occurred in 2 diffuse peritonitis and 13/14 tubo-ovarian abscesses. Surgery used in severe salpingitis and diffuse peritonitis, principally consisted in anexectomy, peritoneal toilet and drainages. No hysterectomies were performed. Colpotomy drainage was used as a laparotomy complement or as unique drainage. Severe complications of surgery occurred in 10.5%. Failure in antibiotic treatment, surgery and complications were present with preference in PID with EB. After PID 26.5% of women had both Fallopian tubes damaged; in 39.7% tube damage was not evaluated and in 34.2% one tube rested in health. Damage did not depend of bacterial etiology. Conclusion on the necessity of adequate prevention of this disease and it should need education related to the roll of STB and standards about the IUD use.

Associaçäo entre salpingite esquistossomótica e gravidez ectópica: relato de um caso / Association between bilharzial salpingitis and ectopic tubal pregnancy: report of a case

É apresentando um caso raro de associaçäo entre esquistossomose tubária e gravidez ectópica. Säo observados detalhes clínicos da associaçäo e sua importância no prognóstico reprodutivo da paciente.

Síndrome de Fitz-Hugh-Curtis / Fitz-Hugh-Curtis syndrome

El síndrome de Fitz-Hugh-Curtis se define como la presencia de una perihepatitis asociada a salpingitis. Los agentes etiológicos reconocidos hasta la fecha son Chlamydia trachomatis y Neisseria gonorrhoeae. El cuadro clínico de este síndrome es inespecífico y puede ser confundido con procesos inflamatorios o infecciosos del tubo digestivo, aparato urinario y respiratorio, en los cuales la manifestación sintomática fundamental es el dolor en hipocondrio derecho. El diagnóstico debe de sospecharse en aquella mujer joven con vida sexual activa que tenga antecedentes de promiscuidad en ella o en su pareja, que se queje de dolor subcostal derecho. Es más probable el diagnóstico si se cuenta con el antecedente de enfermedad pélvica inflamatoria y más aún, si se tiene evidencia de que ésta sea causada por Neisseria gonorrehoeae y/o Chlamydia trachomatis. El diagnóstico definitivo se realiza con la visualización directa de la adherencia perihepática por laparoscopía o laparotomía. Se recomienda la primera. El tratamiento médico es a base de cefalosporinas y dicloxacilina y en algunos casos se requiere de la extirpación quirúrgica del proceso adherencial para mitigar el dolor.

Síndrome de Fitz-Hugh-Curtis: aspectos clínicos e bacteriológicos / Fitz-Hugh-Curtis syndrome: clinical and bacteriological aspects

A síndrome de Fitz-Hugh-Curtis (peri-hepatite) é uma das complicaçöes mais importantes da doença inflamatória pélvica aguda em virtude da dificuldade em se estabelecer o diagnóstico correto, podendo implicar em condutas terapêuticas inadequadas. Estudaram-se 53 pacientes portadoras de graus variáveis de salpingite aguda nos seus aspectos clínicos, laparoscópicos e bacteriológicos. Sete (13,2%) pacientes apresentaram quadro clínico de peri-hepatite, confirmado por laparoscopia. As principais conclusöes foram: 1 - É elevada a incidência desta entidade em nosso meio; 2 - O comprometimento peri-hepático näo guarda relaçäo com a intensidade do acometimento inflamatório tubário; 3 - Inexistem alteraçöes enzimáticas acompanhando o processo peri-hepático; 4 - Há indícios de que o agente prevalente, em nosso meio, seja a N. gonorrhoeae

Laparoscopía en procesos pelvianos agudos / Laparoscopy in acute pelvic processes

1. Se analizan 70 laparoscopias efectuadas como procedimiento diagnóstico en procesos inflamatorios pelvianos agudos. 2. Se analizan estas pacientes con signos y síntomas de salpingitis aguda, llegándose a su confirmación laparoscópica en el 52,9% de los casos. 3. Se confirma la utilidad del la laparoscopia en el diagnóstico precoz y oportuno en los casos de salpingitis aguda, y en el diagnóstico diferencial de otras patologías pelvianas agudas. 4. Se describe una clasificación de salpingitis aguda de acuerdo con los grados de severidad visualizados a la laparoscopia. 5. En nuestra experiencia, no existirían contraindicaciones para el empleo de la laparoscopia en el diagnóstico diferencial de procesos inflamatorios pelvianos agudos

Acute salpingitis in the adolescent female.

Acute salpingitis is an important complication of sexually transmitted disease in young women and should be considered in the differential diagnosis of abdominal pain in all young women. Many organisms, in addition to N. gonorrhoeae, have been associated with this tubal infection giving support to polymicrobial etiology. However, the exact pathophysiologic role of these organisms needs to be clearly defined. The microbiology of acute salpingitis, through direct culture from the site of infection, the fallopian tubes, needs to be clearly elucidated. Early recognition and treatment of acute salpingitis is essential in preventing the major long-term problem, involuntary infertility. Curran has estimated the reproductive outcome for a cohort of adolescent women reaching reproductive age in 1970. By the year 2000, there will have been one episode of salpingitis for every two women; 15% will be hospitalized for salpingitis with over half of these women requiring major gynecologic surgery; 10% will be rendered nonsurgically sterile; and 3% will have experienced an ectopic pregnancy. Adolescent females may be more susceptible to upper genital tract infection than older women due to possible unique biologic characteristics and sexual behaviors. Prospective microbiologically controlled studies of women with salpingitis using laparoscopy need to be developed to evaluate treatment regimens. Until such studies are undertaken, diagnosis, treatment, and fertility in women with acute salpingitis will remain unsatisfactory.