Diagnosis Of Tubo-ovarian Abscess Research Articles

283: Role of Early Bedside Transvaginal Ultrasonography in the Diagnosis of Tubo-Ovarian Abscess

283: Role of Early Bedside Transvaginal Ultrasonography in the Diagnosis of Tubo-Ovarian Abscess

Fallopian tube carcinoma presenting as tubo-ovarian abscess: a report of two cases with literature review

Preoperative diagnosis of fallopian tube carcinoma is difficult, with fewer than 5% being diagnosed preoperatively. We describe tubal carcinoma, presenting as a tubo-ovarian abscess in two 47-year-old women. Both patients presented with abdominal pain, pelvic mass, and fever. Both patients were treated as having a tubo-ovarian abscess but failed to respond to therapy. During surgery a metastatic right tubal carcinoma was found. A definite operation was performed in both patients. Three additional cases of fallopian tube carcinoma, presenting as acute pelvic inflammatory disease, were found while reviewing the English literature. Actually all these three cases presented as tubo-ovarian abscess because of the existence of tender pelvic mass. Carcinoma of the fallopian tube should be considered in the differential diagnosis of tubo-ovarian abscess in those who failed to respond to a previously unreported clinical presentation.

Reduction in Hospitalized Women With Pelvic Inflammatory Disease in Oslo Over the Past Decade

The authors compared the demographic and medical variables of Oslo women hospitalized with pelvic inflammatory disease (PID) in the years 1990-1992 and 2000-2002. A retrospective review of medical records identified 523 patients suitable for study. The total number of hospital patients with PID dropped from 301 in the first period to 222 in the second (P =.001). Overall, three fourths of patients in this series were diagnosed with salpingitis and one fourth had tuboovarian abscess. Two women were diagnosed with oophoritis. The percentage of women hospitalized with PID who were diagnosed with salpingitis decreased from 79% in the early years to 70% in the later study period. Correspondingly, the diagnosis of tuboovarian abscess in these women increased from 20% to 30% (P =.009 for difference). Clinical and demographic differences in patients with PID were similar between 1990-1992 and 2000-2002, except that more women in the early period had a history of PID (26%) compared with the later period (14%) (P =.005). This difference was significant for women diagnosed with salpingitis (24% vs. 10%, respectively; P =.002) but not for those with tuboovarian abscess. The mean length of hospital stay dropped from a mean of 5.8 days in 1990-1992 to 3.8 days in 2000-2002 ((P <.001). The percentage of women with PID who had an IUD did not change from the first to second period (35% and 34%, respectively). IUD use was associated with tuboovarian abscess or salpingitis in 51% and 31%, respectively, of women with these diagnoses in 1990-1992 (P =.025), and 61% and 25%, respectively, in 2000-2002 (P <.001). Maximum C-reactive protein and leukocyte counts were consistently higher for women with tuboovarian abscess compared with those with salpingitis, but the overall measurements increased significantly in the 10 years between time periods. In 1990-1992, maximum C-reactive protein and leukocyte counts were 176 in the abscess group and 89 in the salpingitis patients compared with 237 and 142, respectively, in 2000-2002 (P <.001). Overall, 68% of the women hospitalized with PID underwent surgery. Surgery was performed in almost all patients with tuboovarian abscess (98%), but the percentage of salpingitis patients who underwent surgery decreased from 67% in 1990-1992 to 49% in 2000-2002 (P =.03).

Isolated Tubal Torsion Managed Laparoscopically

Adnexal cystic lesions in women of reproductive age are common. Most are functional ovarian cysts, followed by paraovarian cysts, hydrosalpinx, and adnexal torsion. A 34-year-old woman experienced mild abdominal pain, nausea, and low-grade fever. She received empiric antibiotics in an outpatient clinic after a diagnosis of tubo-ovarian abscess. After 3 days she was referred to our hospital with no improvement in symptoms or signs. Isolated fallopian tube torsion was diagnosed and successfully treated by laparoscopy. Laparoscopy played an important role in making an accurate diagnosis and avoiding unnecessary delays in treatment.

CT findings in tuboovarian abscess.

Pelvic inflammatory disease with tuboovarian abscess can cause a wide range of radiologic abnormalities. Although the diagnosis of tuboovarian abscess is usually straightforward and is based on clinical and sonographic findings, unusual or unsuspected cases may be confused with other pelvic or abdominal diseases. The purpose of this essay is to illustrate the CT findings in tuboovarian abscess.

Tubo-ovarian abscess in adolescents

Little information is available regarding the clinical presentation of tubo-ovarian abscess (TOA) in adolescents and how to distinguish it from uncomplicated pelvic inflammatory disease (PID) specifically in this age group. By chart review, we compared 37 adolescent girls with the diagnosis of TOA (by direct visualization or pelvic sonography) with 28 matched control subjects with PID. The mean age was 17.0 (±1.6); 57% were black. The mean body temperature was significantly higher in the PID group, but a longer duration of pain (>7 days) and a higher erythrocyte sedimentation rate (>30 mm/hour) were significantly related to the presence of TOA. Considerable overlap in clinical presentations was noted between the two groups in history of intermenstrual bleeding, gastrointestinal symptoms, vaginal discharge, and parity. In 29% of the TOA group, an abscess was not suspected on physical examination. Thus, we would recommend that pelvic sonography be used liberally in adolescents with PID with particular focus on those with a prolonged history of abdominal pain and high erythrocyte sedimentation rate.

Contraceptive practice and tuboovarian abscess

The hospital and operative records of 318 women with a discharge diagnosis of tuboovarian abscess (TOA) were reviewed to evaluate the possible relationship between contraceptive usage and the occurrence of TOA. A significantly higher (p < 0.10) proportion of the intrauterine contraceptive device (IUD) users had acute pelvic inflammatory disease and a significantly lower proportion (p < 0.10) compared to users of other contraceptive methods were surgically treated. The proportions of women with unilateral and bilateral TOAs were similar, regardless of the contraceptive method used. This was true whether diagnosis was based on physical examination alone or confirmed at operation.