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kimidaanri posted:
I have had a sonogram and MRI to diagnose a right sided hydrosalpinx that is 11cm in size. That was last spring. There were no symptoms for this it was found on a sonogram because I was feeling pelvic pressure which they feel is from pelvic congestion and an enlarged uterus and I could possibly benefit from a D&C. My doctor wanted to wait 3 months to repeat sonogram to see if it may possibly shrink a bit. I just had another sonogram which shows it is still large with not much change now the doctor wants me in to discuss removing it. I am 38 years old with 3 children and no plans to have more. I am healthy and have never had any surgery before.Is it necessary to remove this if I have no symptoms from it? What are the dangers to leaving it in? Everything I find online talks about the benefits of removing it for fertility reasons only, which I don't care about. We don,t even know how or why this developed. My youngest child is 6 and I haven't had a pelvic sonogram since pregnant with him.Could I have been walking around with it for that long? I don't have any infection that I know of and I am married for 17 years and we do not have any sexually transmitted diseases.Any information you have would be greatly appreciated I would like to go to my doctor well prepared to discuss this but again online information only deals with preserving fertility. At this point if I must lose my tube and my doctor is in there anyway I would probably have her tie the other tube since my husband refuses a vasectomy. I would like to know if that's even a possibility. Thank you again.
J_Harrison_Hohner responded:
Dear kimidaanri: You are correct, we often find asymptomatic hydrosalpinx with no overt reason for them being there (eg no endometriosis, no scaring from an STD). Somehow the Fallopian tube gets closed and fluid begins to fill the tube like a water balloon.

So what might the risks be for leaving it in? It is a large size (11 cm is about 5.5 inches). MULTIPLE literature searches at the National Library of Medicine site do not yield any studies about rupture or leaking from a hydrosalpinx. The following citation describes one of the risks of leaving a large hydrosalpinx in place---ovarian torsion (where the weight of the tube causes it to twist shutting down the blood supply to the ovary:

J Pediatr Adolesc Gynecol. 2006 Aug;19(4):297-9. Links Hydrosalpinx with adnexal torsion in an adolescent virgin patient--A diagnostic dilemma: case report and review of the literature.Pinkert M, Klein Z, Tepper R, Beyth Y. Department of Obstetrics & Gynecology, Meir Hospital, Kfar-Saba, Israel.

Hydrosalpinx is one of the predisposing factors of adnexal torsion. However, because the incidence of hydrosalpinx in adolescent virgin patients is very rare, it may cause diagnostic dilemma, leading sometimes to suboptimal treatment. We present the case of an 18-yr-old female, not sexually active, presenting with acute lower right abdominal pain. The working diagnosis was of a simple ovarian cyst, so aspiration was performed. Abdominal symptoms reoccurred and sonography revealed a large hemorrhagic cystic mass adjacent to an edematous right ovary. The patient was referred to immediate laparoscopy due to suspected right adnexal torsion. On laparoscopy, the right adnexa was twisted three times causing an edematous ovary with a hematosalpinx. Detorsion was performed. Five weeks later, transabdominal ultrasound reviled normal bilateral ovaries and the hematosalpinx disappeared. In conclusion, hydrosalpinx, although very rare in adolescence, must be considered in the differential diagnosis. Aspiration in such cases is not the treatment of choice and moreover, it may cause complications

Yes kimidaanri, it is certainly very feasible to have a tubal ligation done while the enlarged Fallopian tube is being removed. Good thinking! If you decide for female sterilization, depending upon your insurance, you may need to sign a consent form then have a "cooling off" period before the tubal can be done. This is primary an issue in Medicaid patients. Your GYN will know about such policy issues.

You deserve kudos for getting reliable information prior to your next GYN visit. Thanks for writing.

Yours, Jane

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