Benign & Malignant conditions of the Fallopian Tubes

Introduction

The firmbriae of the fallopian tubes pick up the ovum after it is released from the follicle and the cilia of the endosalpinx transport it to the site of fertilization. Sperm are transported by the cilia from the uterine end of the tube laterally to the site of fertilization.

Tubal Infection

The tubes can become blocked by infection (or inflammation following trauma). The result of this can be tubal abscess or hydrosalpinx.

Clinical Features:

Tubal infection may present with pain of an acute abdomen, especially if an abscess has formed. A hydrosalpinx may be symptomless.

Investigations:

Laparoscopy is useful for inspection of the peritoneal aspect of the tubes. Exudate may be seen over the tubes, especially at the firmbriae. If the firmbriae are clubbed, this indicates chronic damage. Fresh and old adhesions may be seen. A hydrosalpinx will be visualized as a swollen tube but not actively infected through the cervix. If there is no tubal blockage , filling of the tubes and free spill into the peritoneal cavity can be seen. Hysterosalpingography is a useful investigative technique.

Management:

Acute infection should be treated appropriately.Infertility due to tubal damage can be treated by tubal surgery or in vitro fertilization to overcome tubal blockage.

Carcinoma of the Fallopian Tube

Primary carcinoma of the fallopian tube is rare, secondary disease from adjacent structures is more common. The symptoms are classically a watery, bloody vaginal discharge. On examination, an adnexal mass may be felt. The treatment is total abdominal hysterectomy and bilateral oophorectomy.