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Abstract: This is a 28-year-old female patient who reported that she had been unsuccessful in pregnancy for 2 years, so she came to our hospital. After completing relevant examinations, the patient was initially diagnosed with chronic tubal inflammation combined with infertility, and then underwent laparoscopic surgery according to the patient’s condition, after which the patient’s disease improved and the patient successfully conceived naturally 5 months later.
Basic information】Female, 28 years old
Type of disease】Chronic tubal inflammation, infertility
Hospital】People’s Hospital of Peking University
Date of Consultation】July 2021
Treatment plan】Surgical treatment (laparoscopic tubal effusion surgery) + intravenous infusion (cefuroxime sodium for injection, metronidazole sodium chloride injection) + oral medication (cefuroxime tablets)
Treatment period】Discharge from hospital 4 days after surgery
Treatment effect] The patient’s condition improved and she had a successful natural pregnancy 5 months after surgery
I. Initial consultation
The patient was 28 years old and came to our hospital because she had been trying to conceive for 2 years without conceiving. The patient complained of hydrosalpinx on one side and pelvic adhesions on the other side. She had a history of 2 abortions and reported a history of irregular lower abdominal pain, not related to her menstrual cycle, and denied a history of other surgeries, appendicitis, pelvic tuberculosis, etc. Subsequent testing of the patient’s hormone levels were essentially normal, anti-Mullerian hormone levels were normal, ovulation monitoring by ultrasound was normal, and the male partner’s semen examination was normal. At present, the patient’s history of chronic pelvic pain and imaging results supported chronic tubalgia. Initially, we considered that the patient might have chronic tubalgia caused by her history of two previous abortions, which in turn caused hydrosalpinx and infertility on one side of the tube.
（The patient was then admitted to the hospital for further examination and treatment. (Tubal angiogram showing typical hydrosalpinx image)
II. Treatment process
After communication with the patient and her family, surgery was preferred because of the patient’s youth, good ovarian function and no male factor causing infertility. After completing the preoperative examination, a combined hysterolaparoscopic operation under general anesthesia was performed. The uterine cavity was normal during the operation, the right tubal effusion was normal under laparoscopy, the left peripheral adhesions were present, the effusion was a thin-walled effusion, there were no dense adhesions between the fallopian tubes and ovaries, only membranous adhesions, and the lumen was rich in cilia. After the surgery, the patient returned to the ward and was routinely given anti-inflammatory treatment with injectable cefuroxime sodium and metronidazole sodium chloride injection after the surgery.
III. Treatment effect
One day after the operation, the patient had the urinary catheter removed and was able to move on the floor, and the bowel resumed venting. On the fourth day after the operation, the patient’s incision initially healed without infection or blood leakage, so the intravenous infusion was stopped and the patient was given oral cefuroxime tablets for anti-infection treatment, and the patient was allowed to be discharged.
The prognosis was good because of the patient’s youth, good ovarian reserve function and thin-walled hydrocele in the fallopian tube. The patient was followed up 5 months after surgery and indicated a successful spontaneous pregnancy with an intrauterine singleton.
IV. Precautions
I am very happy that the patient’s chronic tubal infection was effectively treated, but I also need to advise the patient to pay attention to strengthening nutrition and eating more protein-rich foods, such as fish, milk, eggs, etc. in daily life; pay attention to reasonable rest and avoid staying up late and straining.
In addition, pregnancy after laparoscopic hydrosalpinoplasty needs to be alerted to the possibility of ectopic pregnancy. Therefore, after pregnancy, it is necessary to go to the hospital regularly to improve ultrasound examination to determine whether the pregnancy is intrauterine, to clarify the fetal growth and development, and to take timely treatment if there is any abnormality.
V. Personal insight
Chronic tubal inflammation is often due to persistent inflammation caused by untimely treatment of acute pelvic inflammatory disease, one of the common manifestations of which is hydrocele. The patient, like this one, had a history of abortion, which probably induced chronic tubal inflammation, which in turn caused hydrosalpinx and infertility, so she was unsuccessful in getting pregnant after 2 years of pregnancy preparation, and because she was relatively young, she was able to get pregnant successfully after standard treatment, which is a blessing.
We would like to remind all women who have been preparing for pregnancy to go to the hospital in time to improve the examination, identify the cause and provide the right treatment if they have abdominal discomfort or have failed to prepare for pregnancy for a long time, so as not to delay the condition.