(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient came to the clinic for infertility. After examination and history of the patient, the initial diagnosis was tubal inflammation and secondary infertility. She was given a hysteroscopy combined with laparoscopy and drug treatment. After the operation, the patient’s tubes were restored to patency bilaterally. 2 weeks later, the patient’s body recovered well with normal indexes, and she could prepare for pregnancy after 1 month of physical conditioning.
Basic information】Female, 29 years old
Disease Type】Tuberculosis
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】November 2021
Treatment plan】Hysteroscopy combined with laparoscopic surgery (right tubal ostomy and left tubal sparing surgery) + anti-infection treatment (cefuroxime sodium for injection, sodium chloride injection, metronidazole injection)
Treatment period】5 days of hospitalization and 2 weeks of follow-up after outpatient treatment
Treatment effect] The patient’s tubes were restored to be patent bilaterally, and the indicators were normal, and she was able to prepare for pregnancy after 1 month of body conditioning.
I. Initial consultation
The patient reported that she had one abortion at the clinic in 2019 and had intercourse with her boyfriend half a month after the operation, after which she experienced abdominal pain and a little vaginal bleeding, which was relieved after 2 days of rest and was not taken seriously. After that, she occasionally experienced increased leucorrhea, lower abdominal cramping and lumbar distension, which were especially obvious after intercourse and during menstruation, but the pain was tolerable, so she never sought medical attention. Now she has been married for one year and has a normal sexual life without contraception, but she has not been able to conceive, so she went to the hospital. The ultrasound of the uterus and adnexa showed “hydrosalpinx on the right side of the fallopian tube, no obvious abnormality in the uterus and left adnexa”, and the iodine oil imaging of the fallopian tube showed “obstruction of the umbilical end of the right fallopian tube and incompetence of the left fallopian tube”. The clinical diagnosis was “1. secondary infertility, 2. tubal inflammation”, and she was admitted to hospital.
Treatment history
The patient was admitted to the hospital and underwent preoperative examination and preparation. There were no obvious contraindications to surgery. During the operation, the right fallopian tube was thickened, the fluid in the abdomen was enlarged and the umbilical end was atretic, so the right tubal ostomy was performed to remove the fluid and the left fallopian tube was normal in appearance. After the operation, the patient was resuscitated with anesthesia and returned to the ward safely after awakening. Anti-inflammatory treatment with cefuroxime sodium for injection, sodium chloride injection and metronidazole injection was given to reduce the original inflammation and prevent the recurrence of tubal inflammation after the operation.
III. Treatment effect
Postoperative fluid examination showed that the patient’s tubes were restored to be patent bilaterally. After 5 days of treatment, the patient had normal temperature, good general condition, no abdominal pain, good healing of small abdominal wounds, and no complaints of special discomfort. The results of routine blood tests showed slightly high white blood cells, and it was recommended to continue anti-inflammatory treatment, but the patient requested to be discharged and was given a signed discharge. It was recommended to continue the outpatient treatment for 2 weeks and then follow up. At the follow-up visit, the patient indicated that she was recovering well and had no special discomfort, and after 1 month of outpatient follow-up, the patient’s indexes were normal, and it was recommended to continue the body conditioning for about 1 month to prepare for pregnancy.
IV. Notes
We are glad that after the treatment, the patient’s fallopian tubes were restored to patency.
1. It is recommended that the patient must not have sex too early after the surgery, otherwise it will increase the chance of infection and lead to tubal infection again.
2. as the patient’s post-operative laboratory results have not fully returned to normal, it is recommended to continue treatment in the outpatient clinic until the results are normal.
3. the patient is advised to go to the outpatient clinic for tubal lavage 3-7 days after her next menstrual period to keep the fallopian tubes open.
4. tubal infection may still recur after surgery and anti-inflammatory treatment, so early preparation for pregnancy should be done.
5. Long-term infertility caused by tubal infection may have adverse psychological effects on the patient, so family members should show more understanding and concern.
V. Personal insight
Tubal infection occurs mostly in young women who are sexually active, often caused by inattention to sexual hygiene, and is especially likely to occur when the body’s immunity is low. Since most manifestations of tubal infection are not too obvious, with only occasional lower abdominal cramps, lumbago and increased leucorrhea, they are easily overlooked and only detected and treated when infertility occurs. If patients can be detected and treated early, the development of infertility can be avoided. Therefore, those who have uncomfortable symptoms should seek medical attention as early as possible or undergo routine annual medical checkups.