Trends in the management of pelvic abscesses

Abstract

Tuboovarian abscess (TOA) is an important and common cause of inflammatory pelvic masses in women of reproductive age. It is responsible for approximately 100,000 hospital admissions annually. TOA is a known complication of pelvic inflammatory disease (PID), and its incidence is expected to increase with the current epidemic of STDs. TOAs are especially prevalent in patients infected with HIV. TOA is a polymicrobial process with a preponderance of anaerobic organisms, including the resistant gram-negative anaerobes such as Bacteroides bivius and Bacteroides fragilis. Patients with a TOA frequently present as a diagnostic dilemma for the surgeon. The symptoms commonly mimic those of a perforated appendiceal abscess, and at laparotomy or laparoscopy, the inflammatory process may involve all three organs (ie, ovary, tube, and appendix), making it difficult to assess where the initial insult originated. Patients with TOA usually present with lower abdominal pain and adnexal mass(es). Fever and leukocytosis are usually present, but their absence does not rule out TOA, especially in immunocompromised individuals. This article reviews the causes, diagnosis, treatments, and outcomes of TOA.