Salpingitis isthmica nodosa: a review of the literature, discussion of clinical significance, and consideration of patient management

Carol S. Jenkins; Steven R. Williams; Grant E. Schmidt

doi:10.1016/s0015-0282(16)56207-4

Infertility Tubal Factor

Salpingitis isthmica nodosa: a review of the literature, discussion of clinical significance, and consideration of patient management

Jenkins CS, Williams SR, Schmidt GE

Published October 1993 Fertility and Sterility, 60(4), 599-607

DOI 10.1016/s0015-0282(16)56207-4 PMID 8405510

RRM Academy Synopsis

Salpingitis isthmica nodosa tied to ectopic pregnancy and infertility

Salpingitis isthmica nodosa is strongly linked to ectopic pregnancy and infertility. This 1993 review examines published studies of this tubal lesion. One study found it in 57 out of 100 women with ectopic pregnancy. Only 5 out of 100 controls had it. The authors propose microtubal surgery for some women.

About 6 in 10 women with ectopic pregnancy had the tubal lesion in one study. Source: Jenkins CS et al., 1993, PMID 8405510.

Study at a glance, 1993 review: Salpingitis isthmica nodosa was tied to ectopic pregnancy and infertility. Source: Jenkins CS et al., 1993, PMID 8405510.

Key Findings

Across the incidence studies the review tabulates, the lesion appeared in 0.6% to 11% of healthy, fertile women, depending on study design.
One study of 100 women with ectopic pregnancy found the lesion in 57%, against 5% of controls. Another study found 2.86% against 0.6%.
Six infertile women with the lesion on a first hysterosalpingogram all showed progression on repeat imaging, over 12 to 60 months, defined as a larger lesion or new tubal obstruction.
Microscopic evidence of the lesion appeared in 10 of 42 (24%) infertile women who had surgery for proximal tubal obstruction after a standard infertility work-up.
One year after microsurgical tubocornual anastomosis for tubocornual obstruction, a term intrauterine pregnancy was reported by 27 of 48 women (56.2%). An ectopic pregnancy was reported by 3 of 48 (6.2%).

Interpretation

Three physicians wrote this review. They bring together published studies on salpingitis isthmica nodosa. The studies cover its ties to ectopic pregnancy, infertility, and surgical repair. Incidence findings varied widely across groups of women. The lesion showed up far more often in women with ectopic pregnancy than in women without it. On repeat imaging, the lesion tended to get worse over time. The findings support larger studies of this lesion and of surgical repair.

RRM Context

Restorative reproductive medicine looks for a physical cause of infertility in the tube. It works to repair that cause. The review's proposal fits this principle: repair the diseased tube segment in women who qualify. The goal is to restore the tube itself, so a couple can conceive through it.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objectives

To examine and discuss the pathology, diagnosis, incidence, and patient profile of salpingitis isthmica nodosa and to question its natural history, propose management strategies, and identify areas of promising research.

Design

Over 50 studies were reviewed, evaluated, and compared to offer the clinician a foundation on which to generate treatment plans.

Results

Salpingitis isthmica nodosa is diagnosed by the pathological presence of isthmic diverticula and may be suggested by characteristic changes on hysterosalpingogram. Its incidence in healthy, fertile women ranges from 0.6% to 11%, but it is significantly more common in the setting of ectopic pregnancy and infertility. There are no studies, retrospective or prospective, that clearly dictate appropriate therapy.

Conclusion

Given its progressive nature and probable deleterious effects on fertility, we propose that microtubal surgery be the definitive treatment for qualified women who have salpingitis isthmica nodosa.

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

Topics

Infertility › Tubal Factor › Proximal Tubal Obstruction · Reproductive Surgery › Tubal Surgery › Tubal Anastomosis

Carol S. Jenkins, Steven R. Williams, Grant E. Schmidt

C Jenkins, Steve Williams, S Williams, G Schmidt

PMID 8405510 8405510 DOI 10.1016/s0015-0282(16)56207-4 10.1016/s0015-0282(16)56207-4 Jenkins et al. 1993, Jenkins 1993

Keywords

Fallopian Tubes/pathology, Female, Humans, Hysterosalpingography, Incidence, Infertility, Female/etiology, Pregnancy, Pregnancy, Ectopic/etiology, Salpingitis/complications/diagnosis/therapy

Salpingitis isthmica nodosa: a review of the literature, discussion of clinical significance, and consideration of patient management

Salpingitis isthmica nodosa tied to ectopic pregnancy and infertility

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

Related research

Salpingitis isthmica nodosa in infertility and ectopic pregnancy

Salpingitis isthmica nodosa: technical success and outcome of fluoroscopic transcervical fallopian tube recanalization

Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization

The pathologic spectrum of uterotubal junction obstruction

Keywords