Bilateral Tubo-ovarian Abscesses Research Articles

Navigating a Tubo-ovarian Abscess: A Case Report

Abstract Tubo-ovarian abscess (TOA) represents a severe complication of pelvic inflammatory disease (PID) and can lead to significant morbidity if not promptly diagnosed and managed. We reported a case of a 36-year-old Palestinian woman who presented with fever and severe lower abdominal pain, initially diagnosed as acute pyelonephritis, but later found to have bilateral tubo-ovarian abscesses complicated by extended-spectrum beta-lactamase (ESBL) infection. The case underscores the challenges in managing complex pelvic infections and highlights the importance of timely intervention and tailored antibiotic therapy. Keywords: Pyosalpinx, tubo-ovarian abscess, peritonitis, pelvic inflammatory disease.

Bilateral or unilateral tubo-ovarian abscess: exploring its clinical significance

ObjectivesTo assess the characteristics of patients with unilateral and bilateral tubo-ovarian abscess (TOA).MethodsWomen diagnosed with TOA during 2003–2017 were included in this retrospective cohort study. TOA was diagnosed using sonography or computerized tomography and clinical criteria, or by surgical diagnosis. Demographics, sonographic data, clinical treatment, surgical treatment, and post-operative information were retrieved.ResultsThe study cohort included 144 women who met the inclusion criteria, of whom 78 (54.2%) had unilateral TOA and 66 (45.8%) had bilateral TOA. Baseline characteristics were not different between the groups. There was a statistical trend that women with fewer events of previous PID were less likely to have with bilateral TOA (75.3% vs. 64.1%, respectively; p = 0.074). Women diagnosed with bilateral TOA were more likely to undergo surgical treratment for bilateral salpingo-oophorectomy compared to unilateral TOA (61.5% vs. 42.3%, respectively; p = 0.04). There was no difference in maximum TOA size between groups.ConclusionsThis study detected a trend toward increased need for surgical treatment in women diagnosed with bilateral TOA. These findings may contribute to determining the optimal medical or surgical treatment, potentially leading to a decrease in the duration of hospitalization, antibiotic exposure, and resistance. However, it is important to acknowledge that the results of the current study are limited, and further research is warranted to validate these potential outcomes.

Abdominopelvic tuberculosis in a nonsexually active young woman

An 18-year old female presented with fever to 40.5°C, chills, diffuse persistent abdominal pain, appetite loss, diarrhea, dyspnea, and precordial pain. Her menstrual cycles were irregular. She reported no previous sexual activity and had no previous medical problems, but her parents and an aunt had been diagnosed with pulmonary tuberculosis (TB). She had a body mass index of 20.09 kg/m2 and reported a weight loss of 4 kg over a period of 2 months. Laboratory evaluation demonstrated an inflammatory syndrome, with erythrocyte sedimentation rate of 49 mm per hour, C-reactive protein of 20 mg/dL, fibrinogen 496 mg/dL, ferritin 759 ng/mL, and procalcitonin 2.6 ng/mL. Cancer antigen 125 (CA125) was increased to 214.9 U/mL, although carcinoembryonic antigen and alpha-fetoprotein were negative. Pelvic magnetic resonance imaging revealed bilateral tubo-ovarian abscesses, inflammatory lymphadenopathy, and ascitic fluid between the ileal loops (Figure 1).

106. Recurrent Bilateral Tubo-Ovarian Abscesses in a Non-Sexually Active Adolescent

106. Recurrent Bilateral Tubo-Ovarian Abscesses in a Non-Sexually Active Adolescent

Perforated Appendicitis Masquerading as Bilateral Tubo-Ovarian Abscess

Acute appendicitis is a highly common cause of abdominal pain that presents with nausea and vomiting, characteristic physical exam findings, and imaging evidence of appendiceal inflammation. In the absence of these signs, diagnosis can be difficult. This case report demonstrates an uncommon presentation of appendicitis that led to a delay in diagnosisand aims to discuss the ways in which similar misdiagnoses can be avoided for clinicians in the future.

Case Report of Acute Encephalopathy Due to Bilateral Tubo-Ovarian Abscesses Following Frozen Embryo Transfer

Case Report of Acute Encephalopathy Due to Bilateral Tubo-Ovarian Abscesses Following Frozen Embryo Transfer

The management of tubo-ovarian abscesses associated with appendicitis

A relatively uncommon medical complication, the tubo-ovarian abscess (TOA) can result from ascending pelvic infection in the female genital tract. The paper aims at exploring the characteristics of patients with TOA and at comparing the outcomes of the surgical management with postoperative recovery. A retrospective analysis of 25 cases diagnosed with bilateral, right or left TOA at “St. Apostol Andrei” Emergency Clinical County Hospital Constanta, Romania between January 2019 and December 2020 was performed. The patients’ clinical characteristics, age, environment of origin, socio-economic background, educational level, the means of contraception used, surgical procedures, and postoperative recovery were analyzed. Out of the 25 cases, 40% presented bilateral TOA, 32% right TOA and 28% left TOA and left adnexectomy. In 3 patients (37.5%) with right TOA, appendicectomy was also performed. In 72% of the cases, a median pubicumbilical incision was performed. The remaining 7 patients (28%) with left TOA underwent Pfannenstiel incision. All cases had a favorable postoperative evolution, the patients being discharged 5-9 days after surgery, benefiting from antibiotic therapy 10 days after their discharge. The coexistence of appendicitis and adnexal pathology should raise awareness for adopting a surgical strategy in order to prevent postoperative complications.

English

English

Bilateral Tubo-ovarian Abscesses After Intrauterine Insemination: A Case Report

Background: Infertility is commonly treated through intrauterine insemination (IUI). However, a limited number of reports are available regarding the infectious complications including IUI. Case Report: This study presented the cases of bilateral tubo-ovarian abscesses after IUIs in a 40-year-old woman with secondary infertility. In addition, salpingectomy and hysterectomy were needed despite treatment with triple antibiotic. Moreover, the diagnosis of tubo-ovarian abscesses was confirmed by means of pathological evaluations. Further, the patient responded well to antibiotic therapy following the surgery. Conclusions: Given the ascending trend of pelvic infections, the IUI-assisted violation of the natural cervical barrier can theoretically pose higher risks of this complication to the patients. Therefore, pelvic infections are highly recommended to be rejected before IUI. Finally, the diagnosis and intervention are necessary for minimizing morbidity and optimize treatment as well.

Prevalence of Infections After In-Office Hysteroscopy in Premenopausal and Postmenopausal Women

To estimate the incidence of infection after diagnostic and operative hysteroscopic procedures performed in an in-office setting with different distension media (saline solution or CO2). Prospective, multicenter, observational study (Canadian Task Force classification II-2). Tertiary women's health centers. A total of 42,934 women who underwent hysteroscopy between 2015 and 2017. Of the 42,934 patients evaluated, 34,248 underwent a diagnostic intervention and 8686 underwent an operative intervention; 17,973 procedures used CO2 and 24,961 used saline solution as a distension medium. Patients were contacted after the procedure to record postprocedure symptoms suggestive of infection, including 2 or more of the following signs occurring within the 3 weeks after hysteroscopy: fever; lower abdominal pain; uterine, adnexal, or cervical motion tenderness; purulent leukorrhea; vaginal discharge or itchiness; and dysuria. Vaginal culture, clinical evaluation, transvaginal ultrasound, and histological evaluation were completed to evaluate symptoms. Operative hysteroscopies comprised polypectomies (n = 7125; 82.0%), metroplasty (n = 731; 15.0%), myomectomy (n = 378; 7.8%), and tubal sterilization (n = 194; 4.0%). Twenty-five of the 42,934 patients (0.06%) exhibited symptoms of infection, including 24 patients (96%) with fever, 11 (45.8%) with fever as a single symptom, 7 (29.2%) with fever with pelvic pain, and 10 (41.7%) with fever with dysuria. In 5 patients with fever and pelvic pain, clinical examination and transvaginal ultrasound revealed monolateral or bilateral tubo-ovarian abscess. In these patients, histological examination from surgical specimens revealed the presence of endometriotic lesions. The present study suggests that routine antibiotic prophylaxis is not necessary before hysteroscopy because the prevalence of infections following in-office hysteroscopy is low (0.06%).

Tubo-Ovarian Abscess Caused by Pasteurella multocida in a Young, Intrauterine Device–Wearing Woman Without Animal Contact

Abstract Tubo-ovarian abscesses are usually caused by anaerobic bacteria alone or in mixed infection. Here, we report about a successfully treated 29-year-old patient with bilateral tubo-ovarian abscess caused by Pasteurella multocida. She had no exposure to animals. After the removal of a 1-year-old copper-T intrauterine device at the time of hospitalization, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed by laparotomy because of the level of the inflammatory lesion of both ovaries. After the administration of antibiotic combination, the patient was discharged home on the fifth postoperative day. In the setting of a tubo-ovarian abscess, rare zoonotic pathogens, such as P. multocida, should also be considered as a causative agent of the infectious process even in the absence of direct or indirect contact with animals. It seems that the asymptomatic colonization of the vagina and the intrauterine device with P. multocida may happen also from unknown origin of the environment with the consequences of severe pelvic infection with tubo-ovarian abscess formation.

Fatal Pulmonary Embolism in the Setting of Immune Reconstitution Inflammatory Syndrome Attributed to Ovarian Tuberculosis.

In developed countries, tuberculosis remains a health care challenge due to human immunodeficiency virus (HIV) and immigration from endemic regions. The Centers for Disease Control and Prevention reported 9557 new cases in 2015, with extrapulmonary involvement in 20.2% of the cases. We present a 33-year-old woman from Cape Town, South Africa, who developed abdominal pain and fever while working on a cruise ship. She sought medical where she underwent computed tomography of her chest, abdomen, and pelvis with findings suggestive of pulmonary tuberculosis and an 8.9-cm pelvic mass. HIV testing was positive and the patient was started on antiretroviral therapy. Bronchoscopy confirmed the presence of acid-fast bacilli, and she was started on rifampin, isoniazid, pyrazinamide, and ethambutol. She remained persistently febrile, raising suspicion for immune reconstitution inflammatory syndrome. However, despite empiric antibiotics, the patient remained persistently febrile, tachycardic, and on day 10 of admission she went into ventricular fibrillation and expired. Autopsy revealed an occlusive thrombus in the left main pulmonary artery in addition to necrotizing granulomata in multiple organs and bilateral tubo-ovarian abscesses. Postmortem cultures for were positive for Mycobacterium tuberculosis, all consistent with disseminated Mycobacterium tuberculosis. Although previous reports underscore the association between tuberculosis and hypercoagulability, the exact mechanism remains unknown. In this article, we report a case of disseminated tuberculosis complicated by bilateral tubo-ovarian abscesses with fatal pulmonary thrombus formation.

Tubo-Ovarian Abscess in a Virginal Adolescent With Labial Agglutination due to Lichen Sclerosus

Lichen sclerosus is a chronic inflammatory disease affecting primarily the anogenital region and may cause symptomatic labial agglutination. We describe an unusual presentation of this condition in a postmenarchal, virginal girl. A 14 year-old girl presented to the Emergency Department of a tertiary children's hospital with acute urinary retention. A perineal inspection revealed labial fusion starting anteriorly and covering up almost two third of the introitus (Figure 1A). Because she was able to void during the assessment period in the Emergency Department, her labial adhesions were managed conservatively with topical estrogen and sitz baths. Ten days after initial presentation, she developed acute onset abdominal pain with fever. Abdominal ultrasound and magnetic resonance imaging revealed tubo-ovarian abscesses mainly in the right ovary and both fallopian tubes (Figure 2A and 2B). The patient was admitted to the hospital and started on intravenous antibiotherapy according to recommendations of infectious diseases specialists. Since adequate clinical response was not achieved with optimal medical treatment, drainage of bilateral tubo-ovarian abscesses was done by the interventional radiology under general anesthesia. In the same session, a simple division of the labial agglutination and vulvar biopsies were performed by the pediatric and adolescent gynecology team with a preliminary diagnosis of vulvar lichen sclerosus based on the clinical features of the patient (Figure 1B). Pathology, although not conclusive, supported the clinical impression. During her inpatient follow up, a second imaging-guided abscess drainage was required, four days after the first procedure, due to insufficient clinical improvement and residual right tubo-ovarian abscess detected on repeated abdominal magnetic resonance. After 3 weeks of intravenous antibiotherapy, the patient was discharged with oral antibiotics and clobetasol propionate 0.05% ointment for local treatment of the lichen sclerosus. The outpatient follow up has gone uneventfully and no recurrence of labial agglutination has been observed. The proposed mechanism for this rare complication of vulvar lichen sclerosus is vaginal pooling of urine due to significant labial agglutination, leading to ascending infection, pelvic inflammatory disease and tubo-ovarian abscesses. In conclusion, vulvar lichen sclerosus should be considered in cases of labial agglutination with atypical findings such as older age and anterior location. Finally, this rare presentation of vulvar lichen sclerosus reminds us that pelvic inflammatory disease and tubo-ovarian abscess must be kept in mind in the presence of fever, abdominal pain and adnexal mass, even in virginal adolescents. The existence of obstructive lesions of the genital tract should further increase the suspicion for these infections.Figure 2A and B. Pelvic MRI showing the tubo-ovarian abscessesView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Tubo-ovarian abscesses with elevated CA-125: A case report

Introduction: The detection of pelvic masses with an elevated blood cancer antigen 125 (CA-125) level is highly suggestive of ovarian cancer. However, various benign and inflammatory gynecological conditions and non-gynecological processes, such as liver and pulmonary diseases, may be associated with an elevated serum CA-125 level, especially in premenopausal women. Case Report: An 18-year-old female patient with lower abdominal pain for three days presented to our hospital. No fever was noted. Blood cancer antigen 125 (CA-125) level was elevated (660 U/mL; normal value, <35 U/mL), while the levels of other tumor markers (α-fetoprotein, carcinoembryonic antigen, β-human chorionic gonadotropin, and CA-199) were within normal limits. Transabdominal ultrasonography showed multicystic lesions with interior septation in the adnexal regions on both sides, suggesting the presence of cystic masses in both ovaries. Contrast-enhanced magnetic resonance imaging (MRI) revealed dilated and tubular structures with fluid-fluid level, wall thickening, and enhancement in the right pelvic cavity, and oval and septated masses with wall thickening and enhancement in both adnexal regions. A MRI diagnosis of right tubo-ovarian abscess and left ovarian abscess was made. Laparoscopy confirmed bilateral tubo-ovarian abscesses with pelvic adhesion. Right salpingectomy, left partial salpingectomy with end-to-end anastomosis, and adhesiolysis were performed. The patient was discharged with an uneventful course five days later. The blood CA-125 level dropped to 127 U/mL in 1 week, and to a normal value (6.5 U/mL) five months after surgery. Conclusion: Using CA-125 in isolation has limited value in differentiating benign from malignant pelvic masses. CA-125 levels are elevated in ovarian malignancy, as well as in pelvic inflammation, especially in a young woman with a sexual history. Clinical history and radiological information from US, CT, MRI and PET/CT provide important additional information for the disease entity. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(9):583–586. www.ijcasereportsandimages.com Yeung et al. 583 CASE REPORT OPEN ACCESS Tubo-ovarian abscesses with elevated CA-125: A case report Kwok Wan Yeung, Hsin Chih Chao

An Unusual Case of a Forgotten IUCD for 22 Years

Background: Reliable, reversible most widely used, contraceptive method worldwide is intrauterine device (IUCD). The association between tubo ovarian abscess formation and the presence of an intrauterine device is well recognized. Case Report: We report a case of forgotten IUCD for 22 years in 41 years woman with Tubo Ovarian mass. No history suggestive of STD or chronic illness or immunocompromised condition. After first child (22 years ago) she never conceived, had on and off abdominal pain, patient was unaware of IUCD insertion and did not had any gynaec checkup. She was admitted for abdominal pain since 2 days. Abdominal palpation revealed vague tenderness in left iliac region and mass about 8x6 cm size. No guarding or rigidity. Her pelvic examination revealed the IUCD string with mild discharge and IUCD was removed. Bimanual examination revealed marked cervical motion tenderness and left adnexal tender. Tense mass felt per abdomen was felt per vaginum. Rectal examination was normal. USG - Abdomen and Pelvis-complex TO mass left side about 5cmx8cm with minimal fluid on POD. Patient was on IV fluids and parenteral antibiotics. After two days patient developed general peritonitis, hence emergency Laparotomy was done. After informed consent Total abdominal Hysterectomy with omentectomy was done. Histopathology confirmed bilateral tubo ovarian abscess and Omentum - Micro abscess. Conclusion: Only after concerned IUCD to be introduced and long-term users of IUCDs remain at risk for serious, indolent pelvic infections and hence counseling should be given before insertion and need for follow up should be stressed.

OP20.09: A single centre experience with ultrasound‐guided drainage of tubo‐ovarian abscess

The aim of the study is to describe our experience with ultrasound guided drainage of tubo-ovarian abscess with concomitant use of antibiotics in a second level center. Seven women diagnosed with a tubo-ovarian abscess and treated with transvaginal ultrasound guided drainage with concomitant use of antibiotics, between January 2011 and January 2014, were reviewed. Intravenous antibiotics were administered as soon as the diagnosis was reached and transvaginal ultrasound guided aspiration of the abscess material was performed within 48 hours with no need of anaesthesia. Transvaginal route was used since it provides a better visualization and access to the region of interest than other ultrasound routes. All cases but one (85%) improved clinically within 48 hours of aspiration and only one required surgery due to refilling of a bilateral tubo-ovarian abscess 48 hours after drainage. Mean hospital stay was 4 days (range 2-5). No procedure related complications were diagnosed. A follow up ultrasound six months after the drainage showed in 4 cases sonographic markers of chronic tubal inflammatory disease but in all cases the patients remained asymptomatic. Transvaginal ultrasound-guided drainage with concomitant antibiotics appears to be a safe, efficacious and well tolerated procedure in the treatment approach of tubo-ovarian abscess as reported in the literature. We consider this approach as a feasible alternative to surgical drainage whenever indicated.

Ultrasound Diagnosis of Bilateral Tubo-ovarian Abscesses in the Emergency Department

Transverse transabdominal ultrasound of the pelvis performed with a 5-2MHz curvilinear probe demonstrates bilateral complex septated adnexal masses.

Primary Bilateral Fallopian Tube Carcinoma The Report of a Single Case with Review of the Literature

Primary fallopian tube carcinoma is an extremely uncommon neoplasm of the female genital tract. Primary Fallopian Tube Carcinoma (PFTC) has a clinical and a histological resemblance to Epithelial Ovarian Cancer (EOC). We are reporting a case of PFTC in a 55 year old tubectomized, postmenopausal woman with the non-specific complaints of a watery vaginal discharge and lower abdominal pain. The clinical and radiological findings suggested a bilateral tubo-ovarian abscess. On laprotomy, a bilateral fallopian tube tumour was seen, with a focal extension to the surface of the right ovary from the right fallopian tube. Total abdominal hysterectomy, bilateral adnexectomy andomentectomy, along with excision of the draining lymph nodes, was done. The histopathological examination revealed a bilateral papillary serous carcinoma of the fallopian tube. The patient was treated with adjuvant chemotherapy with Paclitaxel. There was no evidence of any recurrence, after 2 years of regular follow up. The clinical signs and symptoms of fallopian tube neoplasms are usually non-specific. The primary treatment remains a surgical resection, followed by adjuvant chemotherapy or radiation. The prognosis is poor, although long-term survivors have been reported.

Extramedullary Hematopoiesis Involving Uterus, Fallopian Tubes, and Ovaries, Mimicking Bilateral Tuboovarian Abscesses

Extramedullary hematopoiesis (EMH) is normal during fetal life, but after birth, the presence of EMH is considered to be abnormal. The most common sites for EMH are the liver, the spleen, and paraspinal regions of the thorax; however, it has been reported to involve virtually any organ or tissue. To our knowledge, this is the first reported case of EMH involving the entire upper genital tract, including the uterus, fallopian tubes, and ovaries. A 43-yr-old African American woman presented with a tender pelvic mass and a markedly elevated white blood cell count. Imaging was consistent with bilateral tuboovarian abscesses. Laparotomy and removal of uterus, tubes, and ovaries and bone marrow biopsy confirmed chronic myelogenous leukemia in the chronic phase and EMH in the cervix, endometrium, and ovaries, and no evidence of infection. We believe this to be the first reported case of EMH involving all organs of the upper genital tract presenting in a patient who has chronic myelogenous leukemia but not in blast crisis. This case illustrates the importance of a broad differential diagnosis when managing a patient with a pelvic mass and the value of a multidisciplinary team approach.

Abdomen agudo como presentación de absceso tubo-ovárico en adolescente sexualmente inactiva

Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease (PID) rarely found in sexually inactive girls. We report the case of a 13-year-old sexually inactive adolescent who presented with abdominal pain, fever and diarrhea. The patient was diagnosed with bilateral tubo-ovarian abscess, which was resolved by laparoscopic drainage of the abscess and antibiotic therapy. Early diagnosis and treatment are essential to prevent further sequelae including infertility, ectopic pregnancy and chronic pelvic pain. TOA should be included in the broad differential diagnosis of abdominal pain with fever in adolescent girls regardless of sexual history.Currently, laparoscopy is the surgical treatment of choice because it produces less postoperative morbidity.