Salpingitis isthmica nodosa (SIN), also known as diverticulosis of the fallopian tube, is nodular thickening of the narrow part of the

uterine tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (: salpinx), are paired tubular sex organs in the human female body that stretch from the ovaries to the uterus. The fallopian tubes are part of the female reproductive sys ...

, due to

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

Signs and symptoms

SIN is associated with

infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...

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 sympto ...

, and may present as either.

Pathology

It is characterized by nodular thickening of the tunica muscularis 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 Hysterosalpingography (HSG), also known as uterosalpingography, is a radiology, radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It is a special x-ray procedure using Contrast ...

, 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. Types Approximately 20% of ...

and

hydrosalpinx A hydrosalpinx is a condition that occurs when a fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus). The blocked tube may become substantially distended giving the tube a characteristic sausage-lik ...

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 common ...

, 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.

References

{{Reflist Noninflammatory disorders of female genital tract Gynaecologic disorders Human female reproductive system Human female endocrine system

Signs and symptoms

Pathology

Diagnosis

Treatment

See also

References