44: An alternative approach to tubo-ovarian abscess

Abstract

Tubo-ovarian abscess can be a challenge to manage, with the physician forced to choose between treatment options that are all unpalatable. Conservative inpatient measures are not guaranteed to be effective and they often take several days to work, during which time the patient is suffering. Traditional surgical care utilizing either laparoscopy or open abdominal surgery entails navigating through a difficult operative field of distorted anatomy, inflammation, and bowel adhesions. These problems are mitigated by operating vaginally instead. A posterior colpotomy is utilized to directly enter the abscess pocket, break up residual loculations and copiously irrigate the pelvis. Superior adhesions are avoided which allows for an operation that is both safe and fast. The vaginal pathway for created for continuous drainage is most anatomic compared to alternative interventions. An alternative vaginal surgical approach is demonstrated for the acute and subacute setting that requires little to no surgeon learning curve; and provides a safe, minimally invasive, anatomically sound option that is highly efficacious in rapidly relieving patient suffering.