Diagnosis Of Tubo-ovarian Abscess Research Articles

Practicability of Serum Kallistatin Levels as a Biomarker in the Diagnosis of Tubo-Ovarian Abscess.

Objective: This study investigates the practicability of serum kallistatin as a biomarker in the diagnosis of tubo-ovarian abscess (TOA) because C-reactive protein (CRP) is insufficiently specific for diagnosis. Methods: Thirty patients (control group) who presented for elective gynecological surgeries and 30 who were hospitalized due to TOA (study group) at the Antalya Training and Research Hospital Gynecology Clinic, Türkiye, between January 1 and December 31, 2022, were included in the study. Blood samples were collected for the calculation of complete blood count, biochemistry, CRP, and serum kallistatin values, and the results were recorded in a database. Results: Although no significant differences were observed between the control and study groups in terms of age or body mass index, significant differences were observed in terms of marital status, number of pregnancies, parity number, intrauterine device history, and previous surgical history (p > 0.05). Serum hemoglobin levels (12.61 ± 1.30 vs. 11.47 ± 1.77; p = 0.008), white blood cell (7.9 [6.15 ± 9.7] vs. 17.0 [11.6-19.6]; p < 0.001), neutrophil (4.6 [3.6-6.12] vs. 13.6 [9.25-16.1]; p < 0.001), lymphocyte (2.51 ± 0.71 vs. 2.33 ± 0.69; p = 0.307), and platelet counts (285.63 ± 78.0 vs. 407.03 ± 131.96; p < 0.001), neutrophil-lymphocyte ratio (2.11 ± 0.93 vs. 6.18 ± 2.20; p < 0.001), neutrophil-lymphocyte ratio (123.16 ± 52.63 vs. 184.39 ± 63.90; p < 0.001), hs-CRP (1.20 [5.55-1.92] vs. 240 [138.25-291.0]; p < 0.001), kallistatin (7.18 ± 3.15 vs. 3.83 ± 3.69; p = 0.006), and urine leukocyte values (1 [0.75-3] vs. 3 [1-6.5]; p = 0.038) also differed significantly between the control and study groups. Conclusion: The study findings show that serum kallistatin levels can be used as a biomarker in the diagnosis of TOA. Further studies involving more participants are now needed to test the accuracy of our results.

Image-Guided Percutaneous Drainage Reduces the Need for Surgical Interventions in Patients with Tubo-Ovarian Abscess: A Cohort Study

Objective: Management of tubo-ovarian abscess (TOA) is a challenging healthcare problem especially in reproductive age women. The aim of this study is to determine the current role of image-guided primary percutaneous drainage in avoidance of surgical intervention in the management of TOA. Material and Methods: A total of 76 patients hospitalized in our tertiary care center with the diagnosis of TOA were retrospectively evaluated. The study population was divided into 2 groups based on the treatment modalities as antibiotic treatment (n=48) and image-guided percutaneous drainage (n=28) and evaluated in terms of clinical and laboratory characteristics and the requirement for surgical intervention. Results: Surgical intervention was required in 1 (3.6%) patient treated with percutaneous drainage and in 10 (20.8%) patients treated with antibiotics (p=0.036). The choice of treatment modality was independent of demographic characteristics, clinical and laboratory findings. The size of TOA in percutaneous drainage group was significantly larger compared to the antibiotic treatment group (mean 6.75±1.886 cm versus 5.92±5.88 cm, respectively, p=0.047). Rehospitalization during follow-up was higher among patients treated with antibiotics only compared to percutaneous drainage group (p=0.06). Conclusion: Percutaneous drainage is an acceptable treatment option including large-sized TOA and decreases the requirement of surgical intervention in selected cases.

Tuboovaryan apseli hastalarda sistemik inflamatuvar belirteçlerin medikal tedavi başarısızlığını öngörmedeki yeri

Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA).&#x0D; Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment.&#x0D; Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%).&#x0D; Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.

Tuboovaryan apseli hastalarda sistemik inflamatuvar belirteçlerin medikal tedavi başarısızlığını öngörmedeki yeri

Amaç: Tuboovaryan apse (TAO) olgularında sistemik inflamatuar belirteçler ve Aspartate aminotransferaz/Platelet Index (APRİ) skorun medikal tedavi başarısızlığını öngörmede yeri olup olmadığı araştırıldı. Gereç ve Yöntem: Ağustos 2016 – Ekim 2020 tarihleri arasında TOA tanısı ile yatırılarak tedavi edilen 240 hasta çalışmaya dâhil edildi. Hastaların demografik ve klinik özellikleri, tanı anında bakılan C- Reaktif protein (CRP), Nötrofil lenfosit oranı (NLR), Platelet lenfosit oranı (PLR) ve APRI skoru dosya kayıtlarından elde edildi. Sadece medikal (n=74) tedavi alan veya cerrahi tedavi gereken hastalarda (n=166) bu parametrelerin medikal tedavi başarısızlığını öngörmedeki yerleri araştırıldı. Bulgular: Cerrahi tedavi alan hastaların sadece medikal tedavi alanlara göre ortalama yaşı (40,95 ± 6,96 ve (38,09 ± 7,69), apse boyutu (67,57 ± 19,86 mm ve 52,78 ± 16,63 mm), CRP değeri (140,61 ± 110,88 ve 75,24 ± 36,64 mg/L), beyaz küre (13818,86 ± 5445,80 ve 11845,31 ± 4424,39 μL), nötrofil (11146,81 ± 5284,83 ve 9242,03 ± 4278,60 μL) ve NLR değeri (9.52 ± 6.88 ve 6.64 ± 6.30) anlamlı olarak daha yüksek bulundu. Receiver Operating Characteristics (ROC) eğrisi analizi (95% 0,531-0,682) ile CRP’nin &amp;gt;11,57 olmasının %63,3 sensitivite, %55,4 spesifite ile medikal tedavi başarısızlığını öngördüğü saptandı. Sonuç: NLR, PLR ve APRI skoru cerrahi tedavi gereksinimini öngörmede etkisizdir. CRP başvuru anında cerrahi tedavi gereksinimini belirlemek adına kullanılabilecek bir belirteçtir.

Can antibiotic treatment failure in tubo-ovarian abscess be predictable?

IntroductionWe aimed to identify factors that would predict the success of antibiotic treatment and the need for surgical treatment in tubo-ovarian abscess (TOA) patients. Materials and methodsThe data of 146 patients with a diagnosis of TOA were analyzed retrospectively. Patients were separated into two groups; successfully treated with antibiotics and going under surgery after antibiotic treatment failure. Demographic, clinical and laboratory data of patients were examined between both groups that could determine the success of treatment. ResultsIn the surgical treatment group, age, body mass index (BMI), and C-reactive protein (CRP) values ​​were higher than the antibiotic treatment group (p = 0.017, p = 0.026, and p < 0.001 respectively). Patients who underwent surgery had a significantly larger abscess than those who received antibiotic therapy (79.4 ± 21.1 mm vs. 50.9 ± 13.2 mm, p < 0.001). Cut-off values of the findings, which were identified as risk factors in predicting the failure of antibiotic treatment, were found with ROC analyses. This cut-off was 41.5 years for age (sensitivity 71.3 %, specificity 60 %), 26.72 kg/m2 for BMI (sensitivity 51.5 %, specificity 71.1 %), and 143.5 mg/L for CRP value on admission (sensitivity 68.3 %, specificity 71.1 %). The cut-off for abscess diameter was 62.5 mm (sensitivity 88.1 %, specificity 82.2 %). ConclusionEspecially in large tubo-ovarian abscesses, early surgical intervention should be preferred considering the age, BMI, and CRP values.

1885 Robotic-Assisted Hysterectomy and Bilateral Salpingo-Oophorectomy with Uterine Artery Ligation in a Case of Tubo-Ovarian Abscess with Severe Pelvic Adhesion

Video Objective Surgeries for tubo-ovarian abscess (TOA) may be very challenging due to severe adhesions from the abscess to the surrounding inflamed tissue. Treatment was often limited to drainage of the abscess due to the difficulty of more extensive surgery. This video demonstrates successful robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy and uterine artery ligation with adhesiolysis for treatment of a case with tubo-ovarian abscess. Techniques of visualizing surgical anatomy and localizing the uterine artery will also be demonstrated. Setting A 41 year-old G3P2SA1 female patient presented to our out-patient clinic with lower abdominal pain with fever for 1 month. She had undergone cesarean delivery twice 17 and 18 years ago with no other significant gynecologic history. On pelvic examination, lifting tenderness with moderate odorous discharge was noted. Transvaginal ultrasound showed bialteral adnexal mass, measuring 5 × 2 cm and 5 × 3 cm. She was then admitted to our department under the tentative diagnosis of tubo-ovarian abscess. Interventions Robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy, uterine artery ligation and adhesiolysis was performed on the second day of hospitalization. Conclusion Total hysterectomy with bilateral salpingo-oophorectomy may be feasible in the treatment of tubo-ovarian abscess by using robotic-assisted instruments. Due to the greater precision, better visualization, and higher dexterity of robotic-assisted surgeries.

Tubo-Ovarian Abscesses in Nonsexually Active Adolescent Females: A Large Case Series

PurposeThe aim of the study was to review the incidence, presentation, and management of tubo-ovarian abscesses (TOA) in nonsexually active (NSA) adolescents. MethodsA retrospective chart review was performed at a single children's hospital. We evaluated self-reported NSA females aged < 21 years diagnosed with TOA. Demographics, presenting symptoms, medical history, laboratory studies, imaging, and treatment were reviewed. ResultsSixteen NSA females met inclusion criteria, with one patient presenting with two separate TOAs. Mean age at diagnosis was 14.6 ± 1.8 years; all were menarchal. Presenting symptoms included abdominal pain (88%), fever (76%), and vomiting (53%). Eleven patients (65%) received transabdominal pelvic ultrasound, 2 (12%) had magnetic resonance imaging of pelvis, and 11 (65%) had computed tomography of abdomen/pelvis. All patients had negative gonorrhea and chlamydia testing. Thirteen (76%) had comorbid disease including obstructed hemivagina ipsilateral renal agenesis, active or recent appendicitis, or genitourinary tract anomalies. Sixteen cases underwent drainage via interventional radiology or surgery. Twelve cases (71%) had TOA fluid cultured; five (29%) grew Escherichia coli species. All cases received intravenous antibiotics, and 88% of cases continued outpatient oral antibiotics. ConclusionsAlthough uncommon in NSA females, patients with underlying comorbidities may be at increased risk for TOA formation. Providers should consider the diagnosis of TOA even in NSA females.

A case of obstructed hemivagina and ipsilateral renal anomaly syndrome complicated with pyometra: tips and tricks for laparoscopic hemihysterectomy

A case of obstructed hemivagina and ipsilateral renal anomaly syndrome complicated with pyometra: tips and tricks for laparoscopic hemihysterectomy

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.

Is intrauterine device a risk factor for failure of conservative management in patients with tubo-ovarian abscess? An observational retrospective study

Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA. In this retrospective case-control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72h was followed by surgical intervention. The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p=0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5±6.6 vs. 13.1±4.6, p=0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6±21.4 vs. 49.6±20.6mm, p=0.02). The surgical intervention rate in TOA patients with and without IUD was similar.

Experience of Tubo-Ovarian Abscess: A Retrospective Clinical Analysis of 318 Patients in a Single Tertiary Center in Middle Turkey.

The objective was to identify the clinical and laboratory parameters, ultrasonographic (USG) morphology, and to predict surgical treatment for patients with tubo-ovarian abscess (TOA). Data for a total of 318 patients with a diagnosis of TOA between January 2005 and December 2016 were analyzed retrospectively at a referral center in Turkey. Patients requiring surgical treatment were compared with those who did not with respect to demographic characteristics and clinical, USG, and laboratory findings. Ninety-three (29.25%) patients whose medical treatment failed underwent surgical intervention and a minimally invasive drainage procedure. Menopausal status, diabetes mellitus, long-term intrauterine device use, fever at admission, bilateral and multi-cystic TOA, and TOA size are risk factors for surgical treatment. An abscess size of 6.5 cm was a significant indicator for surgical intervention (odds ratio = 16.632; 95% confidence interval 8.745-31.632; p < 0.05). The area under the curve (AUC = 0.868) in the receiver operating characteristic (ROC) curve analysis was found to be statistically significant for TOA size, with a threshold value of 6.5 cm. The recommended cutoff value for erythrocyte sedimentation rate (ESR) was 61.0 mm/h, and the cutoff point of the C-reactive protein (CRP) level in the ROC analysis was found to be 24.5 mg/dL. There were no complications in the USG-guided drainage surgical treatment group. The TOA size, complex multi-cystic mass image, CRP, and ESR are useful indicators as to whether surgical treatment is required for the management of TOA. The USG-guided drainage was less invasive with fewer complications and should be the preferred surgical treatment.

Comparison of hysterosalpingography and laparoscopy in evaluation of female infertility

Background and Objectives: Laparoscopic surgery (LS) is the most important diagnostic technique for the detection of causes of infertility; however, this method is accompanied by some setbacks. Given the noninvasive nature and cost-effectiveness of hysterosalpingography (HSG), it is widely used as the first-line approach for the evaluation of the patency of the fallopian tubes and uterine anomalies in female infertility. Herein, we aimed to compare the diagnostic values of HSG with LS in the assessment of patency of the fallopian tubes and peritoneal disease in infertile women.Materials and Methods: This prospective, cross-sectional study was performed on 115 infertile women admitted to the Department of Obstetrics and Gynecology in Fatemiyeh Teaching Hospital, Hamedan, Iran, during March 2011- September 2012. Tubal patency, peritubal adhesion, uterine anomalies, and tubo-ovarian abscess (TOA) findings in HSG were compared with laparoscopic findings. Data was analyzed using McNemar's test and Cohen's Kappa. Results: The sensitivity, specificity, and accuracy of HSG for the detection of unilateral and bilateral tubal occlusion were 75%, 91.2%, 89.5%, 75%, 97.2%, and 96.6%, respectively. Furthermore, false-positive and false-negative rates of HSG for the detection of unilateral and bilateral tubal occlusion were 8.7% and 25%, respectively. The accuracy of HSG in detecting uterine anomalies and hydrosalpinx were 93.3% and 93.9%, respectively. Peritubal adhesion and TOA were detected in 61% of the cases with normal HSG. In addition, of the nine cases of bilateral tubal occlusion detected by HSG, six cases were confirmed to have bilateral occlusion using laparoscopy. The comparison between HSG and LS techniques showed a significant difference in diagnosis of distal fallopian tube occlusion (P=0.021) and unilateral fallopian tube occlusion (P<0.001) among infertile women. The comparison between HSG and LS techniques demonstrated a significant difference in diagnosis of TOA (P<0.001) and peritubal adhesion (P=0.033).Conclusion: It seems that the findings of HSG regarding occlusion, hydrosalpinx, and uterine anomalies are reliable. However, due to its low sensitivity in detecting peritubal adhesion, performing LS before initiation of treatment in these patients is necessary to rule out adhesion and to confirm tubal patency.

Usefulness of Serum Procalcitonin Levels in Predicting Tubo-Ovarian Abscess in Patients with Acute Pelvic Inflammatory Disease

We aimed to investigate the clinical importance of serum procalcitonin (PCT) levels in the diagnosis of tubo-ovarian abscess (TOA). Patients diagnosed with pelvic inflammatory disease (PID; n = 36) and patients diagnosed with TOA (n = 42) were included in the study. Sociodemographic characteristics, laboratory and clinical parameters were compared between the 2 groups. Mean PCT level was higher in the TOA group (p = 0.004). Mean length of stay in hospital was longer in patients with TOA (p < 0.001). White blood cell count, neutrophil count, percentage of neutrophils and C-reactive protein levels were higher than normal limits in all patients; however, no differences in these parameters were observed between the groups. A cutoff level of 0.330 ng/ml for PCT revealed 62% sensitivity and 75% specificity in predicting TOA. Serum PCT is a promising inexpensive marker for the diagnosis of TOA in PID patients.

Actinomycosis pelvic abscess after in vitro fertilization

To report a case of pelvic actinomycosis presenting as large, multiloculated abscesses after an in vitro fertilization (IVF) cycle for male factor infertility. A case report and literature review. University hospital. A 31-year-old nulligravid woman presenting with urinary retention, pelvic pain, and fever 6 days after transvaginal oocyte retrieval and an embryo transfer for male factor infertility. Intravenous and oral antimicrobial therapy, and computed tomography (CT)-guided drainage of pelvic abscesses. Clinical and radiologic resolution of symptoms and infection. The CT scan revealed several large, multiloculated pelvic and tuboovarian abscesses. The patient defervesced after 6 days of intravenous antibiotics, but the pelvic pain did not improve. After CT-guided drainage of the pelvic abscesses, the patient's symptoms improved. The drained material was cultured, and the patient was diagnosed with pelvic actinomycosis tuboovarian abscesses, an infrequent cause of tuboovarian abscess and a rare complication of assisted reproductive technology (ART). The patient was switched from intravenous to oral antibiotics and discharged home. Pelvic Actinomyces israelii presenting as pelvic abscesses may occur as a rare complication of ART. Physicians should consider a diagnosis of tuboovarian abscess in a patient reporting fever and pelvic pain after IVF and embryo transfer.

Tubo-ovarian abscesses: A retrospective analysis of risk factors, clinical features, and treatments

Tubo-ovarian abscess (TOA) is a serious inflammatory disease of the female reproductive system including the ovary, fallopian tube, and the surrounding tissues. In this study, we aimed to present risk factors, clinical features and treatment approaches in TOA. The files of 31 patients with a diagnosis of TOA were analyzed retrospectively from January 2007 to June 2012. The patients' risk factors, clinical details, treatment modalities, laboratory results, and complications were recorded. The medically treated patients were divided into two groups: successful and unsuccessful treatment groups. Groups were compared according to the demographic data, risk factors, and mass characteristics. The mean age of patients was 33.12±10.43. Twenty-eight patients (90.3%) were married and 27 of them (87%) were multiparous. Intrauterine device (IUD) were used as contraceptive method in 11 of married patients (35.5%). Nine patients (29%) had history of prior intrauterine or intraabdominal intervention within 6 months. Pelvic inflammatory disease (PID) were in 15 patients (48.4%). At admission, pelvic pain in 31 (100%), vaginal discharge in 24 (77.4%), fever in 17 (54.8%), irregular menstrual bleeding in 14 (45.2%) of patients were recorded. Laboratory findings were elevated erythrocyte sedimentation rate (71%), and increased C-reactive protein level (71%), leukocytosis (61.3%) respectively. The initial diagnosis of hospitalized patients were observed TOA in 14 (45.2%), ruptured TOA in 5, IUD translocation and TOA in 7, the suspicion of a complication of perforated appendicitis in 1 and pelvic mass (teratoma, fibroid degeneration, ovarian cancer, endometrioma) in 4 of patients, respectively. Medical treatment was applied in 13 patients and reached 46.2% success rate. There was no significant difference in between successful and unsuccessful treatment groups with respect of demographic data, risk factors, and the mass characteristics. Surgical procedures were laparoscopic abscess drainage (22.6%), laparotomy and drainage of abscess (32.3%), unilateral salpingooopherectomy (12.9%), and total abdominal hysterectomy and bilateral salpingo-ooferectomy (12.9%), respectively. The bowel injury and sepsis (6.5%), dehiscence (6.5%), and wound infection (3.25%) were observed as postoperative complications. The pelvic masses may be a risk factor in addition to PID and the use of IUD for TOA. The patients with TOA may present with the pelvic mass and pelvic pain without the classic symptoms of infection. Therefore, TOA should be considered in the differential diagnosis of pelvic masses. Although the medical treatment should be the first choice in patients with TOA, suspected cases and ruptured abscesses should be treated by surgery.

Primary tubal carcinoma with a preoperative diagnosis of tubo-ovarian abscess: a case report

Primary tubal carcinoma is a rare carcinoma type that is quite difficult to diagnose preoperatively. In this case report, a patient who was operated by reason of preliminary diagnosis of tuboovarian abscess in our clinic was diagnosed with primary tubal adenocarcinoma histopathologically. The patient was designated as stage Iic, and she received chemotherapy and radiotherapy. She developed recurrence after a remission period, and her illness aggrevated into stage IV. After 36 months from diagnosis, the patient died due to respiratory failure.

Indium-111 Leukocyte Scintigraphy Aids in Diagnosis of Tubo-Ovarian Abscess

Indium-111 Leukocyte Scintigraphy Aids in Diagnosis of Tubo-Ovarian Abscess

Role of Bedside Transvaginal Ultrasonography in the Diagnosis of Tubo-ovarian Abscess in the Emergency Department

Tubo-ovarian Abscess (TOA) is a complication of pelvic inflammatory disease (PID) requiring admission, i.v. antibiotics and, possibly, aspiration or surgery. The purpose of this study was to describe the role of emergency department (ED) bedside transvaginal ultrasonography (US) in the diagnosis of TOA. This was a retrospective review of non-pregnant ED patients presenting with pelvic pain who were diagnosed with TOA using bedside transvaginal US. ED US examinations were performed by emergency medicine residents and ultrasound-credentialed attending physicians within 1 h after clinical assessment. ED US logs were reviewed for the diagnosis of TOA. Medical records were reviewed for risk factors, medical and sexual history, physical examination findings, laboratory results, additional diagnostic testing, hospital course, and a discharge diagnosis of TOA by the admitting gynecology service. A total of 20 patients with TOA were identified over a 3-year period. Ages ranged from 14 to 45 years (mean 27 years). Seven (35%) patients reported a prior history of PID or sexually transmitted disease, and 1 (5%) was febrile. All had lower abdominal tenderness and 9 (45%) had cervical motion or adnexal tenderness. The sonographic abnormalities included 14 (70%) with a complex adnexal mass, 5 (25%) with echogenic fluid in the cul-de-sac, and 3 (15%) patients with pyosalpinx. The discharge diagnosis was TOA by the admitting gynecology service for all patients. Our study illustrates the limitations of clinical criteria in diagnosing TOA and supports the use of bedside US when evaluating patients with pelvic pain and symptoms that do not meet classic Centers for Disease Control and Prevention criteria for PID.

Comparison of CT‐ or ultrasound‐guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo‐ovarian abscesses

The purpose of this study was to compare the outcome of treatment of tubo-ovarian abscesses by imaging-guided drainage and antibiotics vs. intravenous antibiotics alone. A retrospective chart review of all patients hospitalized with a diagnosis of tubo-ovarian abscess was performed. Patients were categorized into two groups. The first group consisted of subjects treated with intravenous antibiotics alone. Patients in the second group had primary image-guided drainage with concomitant intravenous antibiotics. Treatment failures in the primary antibiotics group underwent salvage drainage when feasible. The primary outcome of interest was complete response. Secondary outcomes included need for additional treatment, duration of resolution of fever, total length of hospital stay, and complication rates. We also evaluated the effectiveness of secondary drainage in patients who failed primary antibiotic therapy alone. A total of 58 patients were included in the study. Fifty patients were treated primarily with intravenous antibiotics; eight patients had primary drainage, which was guided by ultrasound in all cases. Complete response was noted in 29 (58%) patients treated with antibiotics alone. All eight (100%) patients in the primary drainage group responded to treatment. Of the 21 treatment failures with primary antibiotics, two underwent surgery and 19 (90.5%) had salvage drainage with either ultrasound or computed tomographic guidance; 18 of 19 salvage drainages led to complete recovery. Subjects in the primary drainage group required shorter hospital stays and showed more rapid resolution of fever. No significant morbidity was noted as a consequence of drainage procedures. A higher failure rate for secondary drainage was noted in older patients, those with larger tubo-ovarian abscesses, and those with a history of pelvic inflammatory disease. Drainage of tubo-ovarian abscesses with concomitant intravenous antibiotics is an effective and safe treatment for the primary or secondary treatment of tubo-ovarian abscesses.

Role of Early Bedside Transvaginal Ultrasonography in the Diagnosis of Tubo-ovarian Abscess

Role of Early Bedside Transvaginal Ultrasonography in the Diagnosis of Tubo-ovarian Abscess