Hydrosalpinx

Hydrosalpinx is a gynecologic condition in which a fallopian tube becomes distended with serous fluid as a result of tubal obstruction, most often from prior pelvic inflammatory disease. It can involve one or both tubes and may be associated with endometriosis or pelvic surgery. The accumulated fluid and distended tube impair tubal motility and embryo transport, reducing natural fertility and increasing the risk of ectopic pregnancy if conception occurs.

Most cases are asymptomatic; when symptoms occur, patients may report pelvic fullness or dull lower abdominal pain. Infertility is a common presentation, and recurrent ectopic pregnancy is a potential complication in women with untreated hydrosalpinx.

Diagnosis relies on imaging. Transvaginal ultrasound typically shows a dilated, fluid-filled adnexal structure adjacent to the ovary, sometimes with thin septations or a characteristic “cogwheel” appearance. Hysterosalpingography can reveal proximal or distal tubal obstruction with a distended tube that fills with contrast. MRI or CT can provide further characterization and assess coexisting pelvic disease.

Management depends on symptoms and fertility goals. Antibiotic therapy is not curative for established hydrosalpinx. For patients seeking fertility or those planning in vitro fertilization, removal of the affected tube (salpingectomy) or tubal occlusion before IVF is commonly recommended to improve pregnancy rates. In carefully selected cases, laparoscopic salpingostomy may be considered, but recurrence is common. For nonfertility or symptomatic relief, surgery remains the main option; in some cases observation is appropriate.

Prognosis is linked to treatment and underlying pelvic disease. With appropriate management, natural conception remains unlikely, but IVF outcomes improve after tubal removal or occlusion.