Unusual Tubal Abnormalities at Tubal Reversal Surgery
Salpingitis Isthmica Nodosa
Salpingitis isthmica nodosa is a nodular swelling of the isthmic segment of the fallopian tube. This fallopian tube abnormality is sometimes encountered at the time of tubal reversal surgery. It often involves the interstitial portion of tube that is within the uterine muscle. The nodule is due to thickening of the muscular wall of the tube around ingrowths or projections of the inner mucus membrane tubal layer into the muscle.
History of Salpingitis Isthmica Nodosa: Scholarly Publications
This tubal abnormality was first described and named by Chiari in 1887 .(1) The name he gave it reflected his belief this was an inflammatory condition. (Salpingitis means inflammation of the fallopian tube.) His contemporary, Kossman, also thought this was an inflammatory condition.(2) An alternate theory of causation was suggested by Recklinghausen in 1896 who believed it to be a congenital abnormality.(3) A third possibility, suggested by Benjamin and Beaver in 1951, is that SIN is an acquired, noninflammatory condition.(4) They believed that the lesion begins as an overgrowth of the inner tubal lining that penetrates into the tubal muscular wall. Then cysts form and the tubal muscular wall becomes enlarged and fibrotic. This has also been termed endosalpingosis, a condition closely related to uterine adenomyosis (a form of endometriosis in which the uterine endometrium grows into the uterine muscle).
HSG Diagnostic Findings
Salpingitis isthmica nodosa can be diagnosed radiographically. A hysterosalpingogram or HSG shows multiple small diverticuli or outpouchings of of x-ray dye protruding from the tubal lumen into the wall of the isthmic portion of the fallopian tubes. Because of its appearance at HSG, radiologists call it tubal diverticulosis.(5)
Clinical Implications
Salpingitis isthmica nodosa is associated with increased rates of infertility by interfering with upward sperm migration and ectopic pregnancy by trapping the fertilized egg within the tube.
Treatment During Tubal Reversal
Salpingitis isthmica nodosa may be encountered at the time of tubal reversal surgery. Because of the dense abnormality of the fallopian tube at its connection with the uterus, tubotubal anastomosis is not possible. In this situation, tubouterine anastomosis or tubouterine implantation can be performed.
December 18th, 2007 at 6:51 pm
Once again Dr. Berger uses information to make sure that his current patients as well as potential patients have the information to allow them to prepare and to make the best decisions for themselves. Dr. Berger’s knowledge, experience, and dedication to patients and their well being are just a few of the reasons that patients give for choosing Chapel Hill Tubal Reversal Center for their surgery.
May 21st, 2008 at 11:39 am
[...] at the time of surgery to have inherent disease of the fallopian tubes due to tubal endometriosis, salpingitis isthmica nodosa, or pelvic inflammatory disease. In these situations, Dr. Berger removes the diseased tubal segment [...]