Management Of Tubo-ovarian Abscess Research Articles

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.

The management of tubo-ovarian abscess - A retrospective analysis of a centre offering outpatient intravenous antibiotic therapy

Background Tubo-ovarian abscess (TOA) carries long-term sequale in women of reproductive age. Consensus of the optimal treatment of tubo-ovarian abscess remains lacking. The aims of this study are to identify risk factors predicting the need for early drainage and compare clinical outcomes of current management practices of TOA. Methods From 2015 to 2019, a retrospective cohort study of 92 women admitted to a tertiary centre for gynaecological surgery was performed. Patients with diagnosed TOA were classified into two groups: treatment with antibiotics only, and those receiving additional drainage. Primary outcomes included length of hospital stay (LoS), length of antibiotic treatment (LoA) and need for re-intervention. Results In this study, 52 women (56.5%) were successfully treated with first line intravenous antibiotics; 40 (43.5%) received surgical drainage. Significant predictors for successful medical treatment only include age < 35 (OR: 0.89, 95% CI: 0.82-0.97) and abscess size < 6cm (OR: 0.17, 95% CI: 0.04-0.64), using multivariate analysis. Pyrexia ≥ 38°C predicted a need for drainage (OR: 3.82, 95% CI: 1.01-8.12). Patients who received additional drainage had significantly longer LoA, LoS and higher rates of re-intervention. Within this group, drainage within 72 hours of admission resulted in a trend towards shorter LoA and LoS than drainage after 72 hours, albeit not statistically significant. Conclusions Parameters include age > 35 years, pyrexia ≥ 38°C and a TOA size > 6cm may independently predict the need for drainage of TOA. Early identification of these patients is imperative for timely surgical intervention to avoid prolonged hospitalisation, antibiotic usage, and patient morbidity. More work is required to identify whether early drainage may reduce length of hospital stay and antibiotic treatment, including identifying certain patient groups who most likely to benefit from outpatient antibiotic intravenous therapy.

Predicting the Need for a Surgical Intervention in the Management of a Tubo-Ovarian Abscess

<h3>Study Objective</h3> To analyze the inpatient management of tubo-ovarian abscess (TOA) and identify factors associated with the need for a surgical intervention. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Community Hospitals with an Academic Affiliation. <h3>Patients or Participants</h3> Women who were managed inpatient with the diagnosis of a TOA between 2014-20 (N=77). <h3>Interventions</h3> TOA managed by intravenous (IV) antibiotics is effective in approximately 70% of patients. For those who fail IV antibiotics, drainage of the abscess is recommended, whether achieved by interventional radiologic means or surgery. We report on the management of TOA in patients who presented to our hospital system. Patients with TOA were identified by International Classification of Disease code N70.93. A confirmation of the diagnosis was made by chart review. Pertinent demographic, medical history, and clinical findings (i.e., abscess size, leukocytosis, fever and treatment) were abstracted from the medical record. <h3>Measurements and Main Results</h3> Descriptive statistics were used to characterize the cohort of patients. The mean age was 41.2 years (S.D. ± 11.12) and mean body mass index was 30.4 kg/m² (S.D. ±10.34). 43% of patients failed IV antibiotics and needed additional therapy. When analyzing data for factors associated with the need for additional therapy, we found that size (>5 cm) was a significant risk with odds ratio (95%CI) 9.423 (1.968- 45.116). When comparing findings amongst co-morbidities, race and ethnicity we found that there was a correlation between size and intervention but no statistical significance. <h3>Conclusion</h3> In our cohort, women with TOA greater than 5 cm were more likely to fail medical management. However, this association did not persist when controlling for other demographic and clinical factors. A larger recruited cohort may reveal a significance of size and the need for intervention. Consideration should be made for early consultation with a minimally invasive gynecologist or interventional radiologist to manage the TOA when there is an increased likelihood of failing medical management.

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.

Impact of early surgical management on tubo-ovarian abscesses

This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Nineteen (38.0%) were treated with antibiotics (medical group) and thirty one (62.0%) were treated surgically on admission (early surgical group). The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%). There was no significant difference in the length of stay between the early surgical and the successful medical group. Impact Statement What is already known on this subject? Tubo-ovarian abscess (TOA) is an inflammatory mass that forms most commonly as a complication of untreated pelvic inflammatory disease (PID). Traditionally, TOAs are treated first with broad-spectrum intra-venous antibiotics, with surgical intervention considered after 72 h. It is not known whether early surgical intervention would be beneficial to patient outcomes compared to traditional management. What do the results of this study add? In this study, we have demonstrated a high success rate with early surgical management. Readmission rate was lowest in the early surgical group compared to the medical and late surgical group. This suggests that early surgical intervention may be beneficial, compared to the standard management of trialling antibiotics and then proceeding to surgery 72 h later. What are the implications of these findings for clinical practice and/or further research? Our study suggests that early surgery may be beneficial in the management of TOAs. Although we were unable to demonstrate statistical significance, our data suggest that it would be worthwhile to investigate white blood cell (WBC) and C-reactive protein (CRP) further as a potential predictor for failure of medical management. In the future, more studies comparing early surgical management with medical and late surgical management could inform clinicians of the best mode of treatment for these patients.

Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence

Purpose: Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities. Methods: This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment. Results: Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA &lt;5 cm. When TOA is &gt;5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA. Conclusions: More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.

Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses.

Management of tubo-ovarian abscesses (TOA) is often complex and may include antibiotics, image-guided drainage via interventional radiology (IR) or surgery. We aim to (i) identify clinical factors that prognosticate primary drainage and (ii) compare outcomes of each treatment regimen. This is a retrospective analysis on patients with TOA, admitted to KK Hospital, a tertiary women's hospital in Singapore from June 2016 to June 2017. Pregnant patients or patients who were discharged against medical advice were excluded. 102 patients were included in this study. 85.3% patients received antibiotics only, while 14.7% patients received antibiotics with IR drainage or surgery (primary drainage) as initial treatment. Subsequently, 20.7% failed antibiotic treatment and required IR drainage or surgery (secondary drainage). Patients aged above 40years, TOA diameter of larger than 7cm and presence of fever were found to be predictive of antibiotic failure, requiring secondary drainage. However, patients with primary drainage had a longer length of stay by 2.69 days (95% CI 1.44-3.94, p value < 0.001), compared to patients successfully managed conservatively. Patients who are above 40years, febrile and have a larger TOA are at a higher risk of medical treatment failure, and should, therefore, be recommended for primary drainage at presentation. Further prospective studies should be conducted with a larger sample size to compare the outcomes of conservative management versus drainage of TOA.

1259 Invasive Procedure in Patients with Tubo-Ovarian Abscess: A Retrospective Study

Study Objective Tubo-ovarian abscess (TOA) is a well-established sequel of acute pelvic inflammatory disease (PID). While as up to 25% of women will experience conservative treatment failure, the factors associated with treatment failure are not clearly-established, and the role of Cancer antigen 125 (CA-125) is under-studied. We aim to evaluate the role of CA-125 in the conservative management of TOA. Design A retrospective cohort study. Setting A tertiary university-affiliated hospital during 2007-2018 Patients or Participants Ninety one patients were diagnosed with a TOA and underwent a trial of conservative management with intravenous antibiotics. Interventions Patients who eventually underwent surgical intervention were compared with patients managed conservatively. Measurements and Main Results Overall, 39/91 (42.8%) underwent an invasive intervention subsequent to failed antibiotic treatment. Patients who experienced conservative treatment failure had higher medians of inflammatory markers as CRP (15.7 vs. 10.8 mg/L, p=0.02), WBC count (14.2 vs. 12.4 1,000/mm3, p=0.04) and platelet count (374 vs. 295 109/L, p=0.04) at admission. Higher levels of CA-125 at admission were found in those who required an invasive intervention (57 vs. 30 U\ml, p=0.02) as well. The largest diameter of TOA at admission was higher in those who required an invasive intervention as compared to those who were successfully treated conservatively ((75 mm. vs. 57 mm, p=0.01). CA-125 level was found to be the only independent factor associated with conservative treatment failure (OR; 95% confidence interval [CI], 1.27, 1.08-1.48, p=0.03). Conclusion Elevated CA-125 serum levels were found to be associated with failure of conservative parenteral antibiotic therapy for TOA. This finding should be better evaluated in a prospective manner.

Clinical value of early laparoscopic therapy in the management of tubo‑ovarian or pelvic abscess

Broad-spectrum antibiotics are the conservative treatment for tubo-ovarian abscess (TOA) or pelvic abscess, but the failure rate of antibiotic therapy remains higher in patients with a larger abscess. The present study aimed to evaluate the clinical value of early laparoscopic therapy in the management of TOA or pelvic abscess. A total of 100 patients were enrolled and their medical records were retrospectively analyzed after excluding 6 patients with malignant diseases. Based on the treatment they had received, the patients were divided into a conservative treatment group (n=41) and an early laparoscopic treatment group (n=53). In the conservative treatment group, 21 patients (51.2%) finally received laparoscopic exploration (late laparoscopic treatment group), and 20 patients (48.8%) achieved a success of antibiotic therapy (successful antibiotic therapy group). The cut-off value of abscess size for predicting antibiotic treatment failure was determined using receiver operating characteristic curve analysis. Multivariate logistic regression analyses were used to explore the association between the clinical variables and antibiotic therapy failure in conservative treatment group. The durations of elevated temperature >38.0°C and hospitalization were significantly longer in the conservative treatment group than those in the early laparoscopic treatment group (all P<0.001). The patients in the late laparoscopic treatment group had a larger abscess size than those in the successful antibiotic therapy group (6.2±1.8 cm vs. 4.8±1.4 cm, P=0.008). An abscess diameter of 5.5 cm was obtained as the cut-off of antibiotic failure, and the sensitivity and specificity were 81.0 and 85.0%, respectively. An abscess diameter of ≥5.5 cm was independently associated with antibiotic failure (odds ratio=5.724; 95%CI: 2.025–16.182; P=0.001). In conclusion, early laparoscopic treatment was associated with a better clinical prognosis than conservative treatment and late laparoscopic therapy for TOA or pelvic abscess patients.

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.

The predictive role of CA-125 in the management of tubo-ovarian abscess. A retrospective study

ObjectiveTubo-ovarian abscess (TOA) is a well-established sequel of acute pelvic inflammatory disease (PID). While as up to 25% of women will experience conservative treatment failure, the factors associated with treatment failure are not clearly-established, and the role of Cancer antigen 125 (CA-125) is under-studied. We aim to evaluate the role of CA-125 in the conservative management of TOA. Study designA retrospective cohort study conducted at tertiary university-affiliated hospital during 2007-2018. Ninety one patients were diagnosed with a TOA and underwent a trial of conservative management with intravenous antibiotics. Patients who eventually underwent surgical intervention were compared with patients managed conservatively. ResultsOverall, 39/91 (42.8%) underwent an invasive intervention subsequent to failed antibiotic treatment. Patients who experienced conservative treatment failure had higher medians of inflammatory markers as CRP (15.7 vs. 10.8 mg/L, p = 0.02), WBC count (14.2 vs. 12.4 1,000/mm3, p = 0.04) and platelet count (374 vs. 295 109/L, p = 0.04) at admission. Higher levels of CA-125 at admission were found in those who required an invasive intervention (57 vs. 30 U\\ml, p = 0.02) as well. The largest diameter of TOA at admission was higher in those who required an invasive intervention as compared to those who were successfully treated conservatively (75 mm vs. 57 mm, p = 0.01). CA-125 level was found to be the only independent factor associated with conservative treatment failure (OR; 95% confidence interval [CI], 1.27, 1.08–1.48, p = 0.03). ConclusionElevated CA-125 serum levels were found to be associated with failure of conservative parenteral antibiotic therapy for TOA. This finding should be better evaluated in a prospective manner.

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

Background/Aim: We aimed to assess the value of early laparoscopic therapy in management of tubo-ovarian abscess (TOA) or pelvic abscess. Methods: This was a retrospective study of all consecutive patients who were initially diagnosed with TOA or pelvic abscess at the local hospital between January 2010 and December 2014. The risks of operation and recurrence were analyzed using logistic analyses. Results: The durations of body temperature > 38.0°C (p = 0.001) and hospitalization (p < 0.001) were longer in the conventional group versus the early laparoscopy group. In the conventional group, 15 (50%) patients finally underwent laparoscopic exploration. The abscess size in the late laparoscopic group was significantly larger than the successful antibiotic treatment group (6.3 ± 1.5 vs. 4.9 ± 1.2 cm, p = 0.010). Abscess > 5.5 cm was independently associated with antibiotic failure (OR 4.571; 95% CI 1.612–12.962). Compared with late laparoscopy, early laparoscopy was associated with a shorter operation time (p = 0.037), less blood loss (p = 0.035), and shorter durations of body temperature > 38.0°C (p < 0.001) and hospitalization (p < 0.001). The cost was the lowest in the patients successfully treated conservatively. Conclusion: Early laparoscopic treatment is associated with shorter time of fever resolution, shorter hospitalization, and less blood loss compared with conventional treatment for TOA or pelvic abscess.

Evaluation, Diagnosis, and Management of Tubo-ovarian Abscess

Evaluation, Diagnosis, and Management of Tubo-ovarian Abscess

Evaluation, Diagnosis, and Management of Tubo-ovarian Abscess

Evaluation, Diagnosis, and Management of Tubo-ovarian Abscess

Re: Diagnosis and management of tubo‐ovarian abscesses

Re: Diagnosis and management of tubo‐ovarian abscesses

Tubo-Ovarian Abscess in Early Pregnancy - Report of a Rare Coexistence

Pelvic inflammatory disease is extremely rare during pregnancy. Both differential diagnosis and management of tubo-ovarian abscesses in pregnancy are challenging and associated with poor obstetric outcomes. The authors present a case of a 17-years-old girl with low abdominal pain for five days. A tubo-ovarian abscess was suspected, with an early pregnancy of unknown location.

54: Laparoscopic management of tubo-ovarian abscesses

The objective of this video is to discuss principles of laparoscopic surgical management of intraperitoneal abscess. In doing so we will review application of basic surgical technique in complex surgical cases. Tubo-ovarian abscesses affect an estimated 66,000 women per year in the United States. While it is an uncommon diagnosis it can lead to significant morbidity and potential mortality for those affected. Standard therapy consists of hospitalization, intravenous antibiotics and not infrequently placement of intraperitoneal drain(s) by radiology. When these conservative measure fail, surgical intervention is necessary. A minimally invasive approach can be daunting in the setting of a diffusely infected pelvis and potential adhesive disease. However, laparoscopy offers several advantages to laparotomy for patients with pelvic abscesses; most notably shorter recovery time and decreased postoperative wound infections. The majority of surgical time is spent in lysing adhesions, both dense and filmy. A variety of techniques are demonstrated using blunt and sharp instruments. Normalization of anatomy is key to assessing if additional procedures are necessary. Abdominal washout and abscess irrigation is often all that is needed to achieve clinical improvement. Adnexectomy is not often required and hysterectomy is rarely needed. Judicious resection of pelvic structures is recommended as removal may lead to further complications and infections. The use of common laparoscopic instruments, basic surgical techniques, abdominal washout and proficient knowledge of intra-abdominal anatomy can safely expedite the recovery of these women.

Tubo-Ovarian Abscess in Second Trimester of Pregnancy after Transvaginal Oocyte Retrieval: Challenges in Management

A 39-year-old primigravida female presented at 16 weeks gestation, with new onset of severe abdominal pain with nausea and vomiting. Her medical history was significant for infertility and ovarian endometrioma during oocyte retrieval. Current gestation was complicated by an emergent laparoscopy with drainage of a ruptured endometrioma in the first trimester. On examination, she had acute abdomen and sonogram showed a viable pregnancy and a 10 cm left adnexal mass. Emergent laparoscopy was performed with aspiration of abdominopelvic pus, ovarian cystectomy and lysis of adhesions. She delivered a live infant at 39.4 weeks via cesarean delivery secondary to arrest of dilation. We believe that when surgical intervention is required, laparoscopy should be considered in the management of tubo-ovarian abscess in pregnancy in the hands of a skilled laparoscopic surgeon.

Ultrasound Management of a Case of Tubo-Ovarian Abscess (TOA) Associated with a Pregnancy of 10 Weeks Gestation

In order to demonstrate the usefulness of the interventional ultrasound in the management of Tubo-Ovarian Abscess (TOA) associated with pregnancy, we report the case of a 29 year-old young woman, with no particular history in which was diagnosed a large left TOA in the context of a pregnancy of 10 weeks gestation. The therapeutic Puncture under ultrasound guidance was performed in an ultrasound room by the radiologist using the technique of “trocar”. The procedure was marked by the setting of an infusion containing antispasmodics prescribed by the gynecologist and a strict asepsis of the area of intervention. It permitted the discharge of 450 cm3 of frank pus. The patient was discharged on antibiotics and pain relief after a normal embryonic ultrasound. Control at 24 h and at one week showed no complications. She gave birth vaginally at term to a eutrophic newborn. We conclude that, interventional ultrasound in the management of TOA associated with pregnancy is safe and effective. It helps avoid major surgery which may have repercussions on the fetus.

Management of Tubo-Ovarian Abscess

Tubo-ovarian abscess (TOA) is a polymicrobial infectious process involving the oviducts, ovaries, and surrounding adnexal tissues, resulting in abscess formation. It is a prevalent disease, predominantly affecting women of reproductive age, with significant short-term morbidity as well as the long-term sequela of infertility. The treatment of TOAs has evolved over time as antibiotics and surgical techniques have improved. Along with the advent of image-guided abscess drainage elsewhere in the abdomen and pelvis, TOAs are now frequently addressed by the interventional radiologist rather than the surgeon. Therefore, it is important for the interventional radiologist to be familiar with the role of image-guided TOA drainage within the global scheme of TOA management, and with technical considerations specific to TOA drainage. This article will review the epidemiology, pathophysiology, and management of TOAs, with particular emphasis on the technical details of performing image-guided TOA drainage.