Salpingitis isthmica nodosa (SIN), also known as diverticulosis of the Fallopian tube, is nodular thickening of the narrow part of the
uterine tube
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ute ...
, due to
inflammation.
Signs and symptoms
SIN is associated with
infertility and
ectopic pregnancy
Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...
,
and may present as either.
Pathology
It is characterized by nodular thickening of the
tunica muscularis
The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
of the narrow (isthmic) portion of the Fallopian tube. In severe cases, it leads to complete obliteration of the tubal lumen. It is uncommonly bilateral.
Gross Findings:
# One or more nodules 1–2 mm, spanning up to 2 cm
# Smooth serosa
Microscopic Findings:
# Glandular epithelium within tubal muscularis propria, in continuation with mucosa or (more commonly) discontinuous
# Haphazard distribution (akin to adenomyosis) or pseudoinfiltrative
# Banal epithelium with tubal differentiation
Diagnosis
Hysterosalpingography, a common technique in the work-up of infertility, is reliable in the diagnosis of SIN, which is seen as small globular collections within the tubal wall, either discontinuous or in continuity with the tubal lumen.
Tubal obstruction
Fallopian tube obstruction, also known as fallopian tube occlusion is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible. Fallopian tubes are also kno ...
and
hydrosalpinx are commonly seen as well. Other techniques include laparoscopic
chromopertubation
Chromopertubation is a method for the study of fallopian tube patency (a state of being open or unobstructed) for suspected infertility in women caused by fallopian tube obstruction. Occlusion or pathology of the fallopian tubes is the most commo ...
, salpingoscopy, and transvaginal hydrolaparoscopy (the latter allows visualization of the tubal mucosa)
Treatment
Once suspected clinically and radiologically, patients with infertility and SIN can be managed with segmental resection with tubo-cornual anastomosis, and recanalization if tubal obstruction is detected. Success with gonadotrophin-releasing hormone analogues (GnRH-a) has been documented in terms of remission of nodularity and tubal patency. If fertility preservation is not desired, salpingectomy is recommended.
See also
*
Vasitis nodosa
Vasitis nodosa is a complication experienced in approximately 66% of men who undergo vasectomy. It is a benign nodular thickening of the vas deferens, in which small offshoots proliferate, infiltrating surrounding tissue. It can be mistaken for ...
*
Salpingitis
Salpingitis is an infection causing inflammation in the Fallopian tubes (also called ''salpinges''). It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, an ...
References
{{Reflist
Noninflammatory disorders of female genital tract
Gynaecologic disorders
Human female reproductive system
Human female endocrine system