Mass in Adnexa and Pelvic Pain With Hydrosalpinx
Q: I had a partial hysterectomy in 2011. During the procedure something went wrong; I am unclear as to what. But I was “nicked” and bled a very large clot that got infected and was re-admitted to the hospital two days later for a week of 3 IV antibiotics. Since then I have had extreme pain in my pelvic area and abdomen when doing sit-ups, push ups, intercourse, or sitting for more than 35 minutes at a time. I can sometimes palpate a bubbled up spot in my lower left abdomen that is very tender to touch. I have been going to the doctor for months because of the issue that includes night sweats, insomnia, pain, irritability and such. Finally they did a CT that revealed this: Standard axial CT images through the abdomen and pelvis obtained. Status post 100 ml Isovue-300 intravenous and 900 ml Redicat oral contrast. Sagittal and coronal reconstruction. Comparison to a similar study dated 12 October 2011.
The lung bases are clear. The osseous structures are unremarkable. The solid abdominal organs including the liver, spleen, pancreas, bilateral adrenals and kidneys significant for a small area of lower attenuation within the mid spleen which is smaller than it was in 2011 and of doubtful clinical significance. The finding suggests a benign process such as an hemangioma. There are a few scattered mesenteric nodes. Otherwise the bowel and vascular structures are unremarkable. The patient is status post hysterectomy. Within the pelvis there are 2 complex adnexal cystic masses measuring approximately 7cm on the right 4 cm on the left. They may be ovarian in origin and also include a hydrosalpinx on the right.
No visualized hernia. I am not sure what this means and I am not getting any answers from the doctors or anywhere. I have three children (1-13 years, 2-3 year twins). I had endometriosis at 17 with surgery. I’m scared.
-By Jess
Reply:
Though there is nothing scary or emergent, you are having a few problems which need attention.
There is a pretty big mass on your right adnexa. As diagnosed on CT, it appears to be a hydrosalpinx.
This problem needs to be attended first.
What Is a Hydrosalpinx?
When a fallopian tube gets blocked distally, fluid starts getting collected in it. The tube starts getting swelled up, giving rise to a retort shaped swelling, called a hydrosalpinx.
The fluid inside may be clear or get infected and turn yellow. It may sometimes be bloody due to small internal bleedings.
Possible Causes of Distal Occlusion of the Tube
- Commonest is PID or any pelvic inflammatory disease. May be the infection you had after your operation, lead to some inflammatory process that blocked the tube.
- Endometriosis
- The surgical procedure in itself may sometimes irritate the tube and trigger fibrosis in its distal end. This may block the tube.
This swelling is quite big and may be the reason for your symptoms.
Symptoms of Hydrosalpinx
- Pain in lower abdomen, especially on straining.
- Infertility
You need to get this condition treated. Your doctor might do a laproscopy to drain or excise this hydrosalpinx.
If the fluid inside is infected, you would require some antibiotics too.
Other Adnexal Masses
Since you have other adnexal masses too, that appear to be from the ovary, further evaluations are required. These masses may be due to hormonal disturbances in your body. Hormonal imbalances may be causing insomnia and irritability, as you mentioned.
Hormonal medications would be required to correct this condition.
It is advisable that you visit a gynecologist and get yourself checked up. You definitely need treatment for your problems.
Take Care,
Buddy M.D.
Hello. I am 33 years old. I have been experiencing abdominal/pelvic pain coupled with distension and bloating for about 6 weeks. Symptoms were intermittent but increased suddenly and became constant 2 weeks ago. I was seen in the ER, CT scan showed diverticulitis of the sigmoid colon and a right, rounded adnexal cyst 5.1 cm x 5.1 cm. My uterus was deviated to the left as well on imaging. Diverticulitis was treated as an inpatient and has resolved; however, pelvic pain and bloating persists. The cyst was not addressed in the hospital and I am concerned this is a large contributor to my symptoms. I have not had a period since April, which is abnormal for me. I have had a negative pregnancy test x 2 and have a tubal ligation. I did have an ectopic pregnancy prior to my tubal. I am also anemic and this is not typical for me. No blood in stool or other bleeding issues. My pelvic region feels “full” and I am very uncomfortable at all times. This seems to be progressing.
The cyst is very likely to be giving you symptoms.
You need to go to a gyne for this. Let her know your symptoms, missed periods and your reports, so that the doctor can proceed towards diagnosing what this cyst is.
The cyst may be tubal or ovarian in nature. There may be an abscess in the tube, hydrosalpinx or some ovarian problem. This needs to be resolved.
There is a thick wall right adnexal cyst measuring 4.0cm*3.4cm. It contained clear fluid and is paining me seriously. Please, what will I take to drain the fluid and to stop paining me?
From where has the cyst originated, the ovary, tube or some other tissue? This is important to know for deciding its management.
Fluid in the tube is called hydrosalpinx. Read above about its management.
Cyst is of the ovary.
Are you having menstrual disturbances?
Respected sir/madam
I am 38 years old. With 3 children- 12, 10 and 2 years.
My USG report as below-
a well defined thin walled, elongated, unilocular cyst on the left postero-lateral aspect of uterus – likely to be hydrosalpinx
Measuring about 7.4*3.2*3.7 cm in size. The left ovary be visualized separate from it. No evidence of internal septation nodularity or hemorrhage is seen.
Please guide. Thanks.
This is very likely to be a hydrosalpinx. this means that one of your tube has water filled in it. Usually, some infection is associated with it.
Your doctor will give you antibiotics. He may suggest a small laparoscopic procedure to drain the lesion.
The condition is not serious, however, needs to be treated early. If not, the infection may spread in other reproductive organs.
Hi doctor. I had a miscarriage in Nov. 2013. I have been ttc since but to no avail until sept. 2014 when I was tested positive for ectopic pregnancy. The scan later revealed adrenal mass of 50mm*51mm and mild copious fluid at the right fallopian tube and hysterotubal junction due to PID. Can the fluid drain with antibiotics and can I get pregnant again?
A little fluid can be absorbed by antibiotic treatment. However, if the fluid is substantial, you may need surgical drainage.
This is essential. If left as such, the tube can start getting fibrosed and eventually get blocked. This would prevent you from becoming pregnant.