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

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.