A ROLE FOR LAPAROSCOPY IN THE MANAGEMENT OF ADOLESCENTS WITH CHRONIC SALPINGITIS

Abstract

The prevalence of venereal disease among adolescents has resulted in a rise in chronic salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of chronic salpingitis in 21 adolescents over a 3 year period. Indications for laparoscopy included: failure to respond to a standard antibiotic regimen, persistence of adnexal mass, or preference in basing therapy on laparoscopic findings. The patients had a mean age of 17½ years and a mean duration of symptoms of 5½ months. Half of the patients had a recent history of vaginal discharge and/or bilateral pelvic pain and/or a history of previous treatment with penicillin. On examination, 55% had pain on motion of the cervix, 75% had adnexal tenderness, half had a palpable adnexal mass and 1 had a positive cervical culture for N.gonorrhoeae. Anatomic findings at laparoscopy included normal pelvic structures in 7, acute salpingitis in 7 and chronic adhesions or scarring in 7. Anaerobic, aerobic and viral peritoneal cultures obtained at laparoscopy from 14 patients resulted in no growth in 10. The 4 with positive cultures had 1 organism identified in each case. Since a definitive diagnosis was made in 21 patients undergoing laparoscopy, treatment could be individualized and consisted of observation in 5, initiation of antibiotic treatment in 12, cessation of antibiotics in 3 and salpingooophorectomy in 1. Anatomic findings were more helpful than the bacteriologic analysis. This experience suggests that laparoscopy increases diagnostic accuracy in management of chronic salpingitis.