Hydrosalpinx

Hydrosalpinx (from Greek hydōr — water, salpinx — tube) is a pathological change of the fallopian tube, characterized by its obstruction distally (ampullary section) by the accumulation of serous transudate in the lumen and saccular expansion of the organ.

Etiology and pathophysiology

The disease is a classic outcome of previous acute or chronic salpingitis (inflammation of the tubes). As a result of the inflammatory process, the fimbriae (‘cilia’ at the end of the tube) adhere to each other (agglutination), closing off the exit to the abdominal cavity. The secretion of the mucous membrane continues to be produced but lacks an outlet. The tube stretches, its muscular walls thin, and the folds of the mucosa flatten. The hydrosalpinx contents represent a sterile or infected transudate containing pro-inflammatory cytokines and substances toxic to the embryo.

Clinical significance

Hydrosalpinx is an absolute cause of tubal infertility (in bilateral cases) and a high-risk factor for ectopic pregnancy. Fluid from the tube may reflux into the uterine cavity, mechanically washing away the embryo or exerting direct embryotoxic effects on the endometrium. This reduces the effectiveness of IVF programs by half and increases the risk of early miscarriages. Therefore, the gold standard prior to the IVF protocol is a laparoscopic salpingectomy (removal of the altered tube).