Ovarian Abscess Research Articles

A Rare Case of Ovarian Abscess Secondary to Salmonella typhi Infection in Women with MRKH: A Case Report and Review of Literature

A Rare Case of Ovarian Abscess Secondary to Salmonella typhi Infection in Women with MRKH: A Case Report and Review of Literature

Analysis of Risk Factors for Surgical Treatment of Acute Female Pelvic Inflammatory Disease.

To investigate the incidence and high-risk factors associated with the surgical treatment of acute female pelvic inflammatory disease (PID). A retrospective analysis was conducted on all inpatients diagnosed with acute female PID, encompassing conditions such as endometritis, salpingitis, tubo-ovarian abscess, ovarian abscess, and pelvic peritonitis, at Dongyang Hospital of Wenzhou Medical University from January 2013 to December 2021. Patients were categorized into two groups: the surgery group (n = 58) and the non-surgery group (n = 399), based on the necessity of surgical intervention (refer to Materials and Methods for surgical indications). Collected data included patient demographics (age, body mass index (BMI)), comorbidities (hypertension, diabetes mellitus), initial laboratory findings upon admission (white blood cell count, absolute neutrophil count, hemoglobin, platelet count, blood urea nitrogen/creatinine, prothrombin time (PT), international normalized ratio (INR), fibrinogen, albumin), surgical records, and postoperative pathology. Univariate and multivariate logistic regression analyses were conducted to ascertain the risk factors associated with the surgical treatment of acute female PID. Out of 457 hospitalized patients with acute female PID, 58 cases (12.7%) required surgical intervention. Univariate and multivariate logistic regression analyses indicated that advancing age correlated with an increased likelihood of surgical intervention in women with acute PID (odds ratio (OR) = 1.052, 95% Confidence Interval (CI) 1.022-1.082, p = 0.001). Additionally, lower serum albumin levels upon admission were associated with a heightened risk of surgery (OR = 0.913, 95% CI 0.859-0.970, p = 0.003), while elevated fibrinogen levels amplified the risk of surgical intervention in these patients (OR = 1.193, 95% CI 1.008-1.411, p = 0.04). Elderly women diagnosed with acute PID, especially those presenting with abscess formation, should undergo prompt surgical intervention if they display high-risk factors such as low albumin levels and elevated fibrinogen levels upon admission.

Repeated recurrence with antibiotic treatment requiring adnexal resection: a case of ovarian abscess with endometrial cyst after oocyte retrieval

Repeated recurrence with antibiotic treatment requiring adnexal resection: a case of ovarian abscess with endometrial cyst after oocyte retrieval

Which treatment should we choose for tubo-ovarian abscesses? Results of an 8-year clinical training in a tertiary center.

Tubo-ovarian abscess (TOA) is inflammation of the pelvic organs, mainly originating from the lower genital tract and intestinal tract. Treatment options include antibiotic therapy, surgical drainage, and radiologically guided (interventional) drainage. In our study, we aimed to evaluate the treatment method to be chosen and thus to manage patients with tuba ovarian abscesses (TOAs) most accurately. This is a retrospective cohort study, and patients who applied to a tertiary center diagnosed with tuba ovarian abscess (TOA) were included. TOA size (cm), pre-treatment C-reactive protein (CRP) value, pre-treatment white blood cell (WBC) value, previous operation type, postoperative complication, and antibiotics used were screened. 305 patients were included in the study, and medical treatment was applied to 140 patients, organ-sparing surgical drainage to 50 patients, and surgical treatment to 115 patients. TOA dimensions measured at the time of diagnosis were significantly lower in patients for whom only medical treatment was sufficient. Pre-treatment CRP levels, WBC levels, and length of stay were significantly lower in patients for whom only medical treatment was sufficient. There was no significant difference between the pre-and post-procedure CRP difference, antibiotics, and hospitalization time. Preferring minimally invasive treatment in cases requiring invasive treatment reduces the frequency of complications. Treatment of tuba ovarian abscesses (TOA) with minimally invasive methods will be more beneficial in terms of patient morbidity.

Ovarian Tube Abscess in an Intrauterine Contraceptive Device User for 5 Years: A Case Report

A tubo-ovarian abscess (TOA) is one of the late complications of untreated Pelvic Inflammatory Disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis.1 It most commonly affects women of reproductive age and nearly 60% of women with TOA are nulliparous.2 The association between tubo-ovarian abscess formation and the presence of an intrauterine device (IUD) is well recognized. It has been suggested that the risk of upper genital tract infection is highest during the immediate period following the insertion of an IUD. We report a case of pelvic inflammatory disease in a 44-year-old woman using an intrauterine contraceptive device (IUD) for more than 5 years, who complained of lower abdominal pain and lumbar pain without fever, and also had a thick-white vaginal discharge. The clinical diagnosis was performed by anamnesis and ultrasound (we found an hypo- hyperechoic mass on the right adnexa size 4.4 x 3.6 x 4.0 cm) and then the patient was treated with triple antibiotics for 3 days. Afterward, the patient was performed using exploring laparoscopy to continue to right salpingo-oophorectomy adhesiolysis left tubectomy, and IUD removal as well. Long-term users of IUDs remain at risk for serious pelvic infections. Every IUD user's patient should be routinely counseled by their gynecologist and tubo-ovarian abscess should be strongly considered in the differential diagnosis of an IUD user who presents with an adnexal mass, abdominal pain, and lumbar pain. The treatment must be a combination of antibiotics and surgery.

EP31.08: Ovarian abscess in third trimester of pregnancy managed by successful vaginal delivery

EP31.08: Ovarian abscess in third trimester of pregnancy managed by successful vaginal delivery

EP30.21: An unusual ultrasound appearance of an ovarian abscess

EP30.21: An unusual ultrasound appearance of an ovarian abscess

Negative pressure wound therapy for the management of surgical site infections with zoonotic, drug‐resistant pathogens on the upper body of the horse

SummaryThis case series reviews the use of negative pressure wound therapy (NPWT) for surgical site infections (SSI) on the upper body of six horses at an academic referral institution between 2016 and 2020. The SSIs consisted of three ventral midline celiotomy incisions post‐abdominal exploratory, one paralumbar flank incision for removal of an ovarian abscess, an incision for resection of a septic jugular vein, and a large defect resulting from the resection of chronically abscessed skin and subcutaneous tissue on the shoulder and pectoral region. All SSIs contained zoonotic, polymicrobial, multi‐drug resistant pathogens (methicillin‐resistant Staphylococcus aureus or extended spectrum beta‐lactamase Klebsiella or Enterobacteriaceae) that were managed without systemic, regional, or topical antimicrobials. All horses were discharged from the hospital, and long‐term follow‐up revealed satisfactory functional and cosmetic outcomes according to owner questionnaires. Duration of NPWT ranged from 4 to 15 days in five horses, but one horse required NPWT for 70 days due to the large nature of the defect. The NPWT system was easy to use, well‐tolerated by patients, and produced acceptable functional and cosmetic outcomes for the clients. By containing wound exudate and reducing daily wound care, it improved hospital biosecurity and reduced exposure to hospital personnel.

AN UNUSUAL MANIFESTATION OF METASTATIC CROHN’S DISEASE: A CASE REPORT

Abstract INTRODUCTION Crohn’s Disease (CD) is a chronic granulomatous inflammatory disease involving any section of the gastrointestinal (GI) tract. Metastatic Crohn’s Disease (MCD) is a rare extraintestinal manifestation of CD defined as cutaneous granulomatous lesions non-adjacent to the GI tract. We present a case of suppurative lymphadenitis as a presentation of MCD. This has not yet been reported in the literature. CASE REPORT A 22-year-old female with a history of iron deficiency anemia and left calf abscess, secondary to Methicillin-Resistant Staphylococcus Aureus (MRSA) infection, was diagnosed with ileocolonic CD at 18. Her CD was complicated by strictures and abdominal and left tubo-ovarian abscesses with a fistula to the sigmoid. She underwent Ileocolonic resection, sigmoid colectomy and left salpingo-oophorectomy. Histology of the ovarian abscesses unveiled granulation tissue with pseudocysts. Azathioprine and Infliximab were started. At 20, the patient reported acute onset of swelling and pain on the left side of her neck. She denied any constitutional symptoms, sick person or animal contacts, travel, use of recreational drugs and sexual activities. Physical exam was remarkable for a tender, rubbery, 2-centimetre left cervical lymph node. The neck Ultrasound showed cervical lymphadenitis. Antibiotic was started and later extended to target resistant infections. Despite this, she reported worsening symptoms. Computed Tomography of the neck noted a collection suggestive of suppurative lymphadenitis. Incision and Drainage (I & D) of the abscess was done; MRSA was detected. Histology exposed necrotizing granulomata encircled by palisading histocytes and giant cells. There was no evidence of dysplasia, fungal, acid-fast bacilli or spirochetes. Further, Human Immunodeficiency Virus serology, Interferon-Gamma Release Assay and chest radiograph were unremarkable. Later, she underwent surgical excision revealing a fistula to the lower mandible. A drain was placed and then removed upon recovery. Meantime, her CD stayed stable; Infliximab was held till the completion of antibiotics. A year later, she reported a tender, swollen lump on the left side of her groin with an ultrasound confirming inguinal suppurative lymphadenitis. Antibiotics were started, and I &D was done for lasting symptoms. The culture and histology were similar to the previous. Considering the history of CD and histology findings, MCD was concluded as the etiology of this patient’s recurrent MRSA abscesses. CONCLUSION Patients on biologic therapy are immunocompromised and presumed high risk for super-infections. In a setting of a persistent infection, despite antibiotics, the possibility of MCD as the cause of lymphadenitis should be raised to cue the clinician to alter therapy and address the MCD within a multidisciplinary setting.

Tubo-ovarian abscess in postmenopausal patients: a tertiary single center experience

Objective: The purpose of the present study was to reveal the experience of a single tertiary center in management and outcomes of tubo ovarian abscess (TOA) in postmenopausal patients.
 Materials and Methods: The present study was conducted between January 2012 and June 2021. One hundred and twenty-seven hospitalized cases of TOA were identified from the medical records and retrospectively reviewed. Collected data included age, parity, menopausal status, intrauterin device (IUD) usage, smoking history, prior procedure, radiological findings, medical and surgical treatments, laboratory findings, pathology and length of hospital stay.
 Results: The mean age of all patients were 39.2 ± 9.8 years, and 22 (17.3%) patients were postmenopausal. The need for surgical intervention, the intrauterine device usage, duration of hospitalization, and malignancy at final pathology were significantly higher in postmenopausal patients (p < 0.05). The mean day for surgery was earlier in postmenopausal patients (p < 0.05). The radiological and laboratory findings were similar according to the menopausal status of patients. Among postmenopausal patients, the mean age at diagnosis, the duration of hospitalization, abscess size, and abscess volume were significantly higher in patients who also underwent surgery compared to those receiving only medical treatment (p < 0.05).
 Conclusion: Postmenopausal patients with TOA differ from traditional abscesses regarding having more comorbidities, a history of extended IUD usage, and a higher possibility of occult malignancies. Postmenapausal patients are more tend to underwent surgeries, however individualized treatment strategies may required in clinical practice.

Protocolo de tratamiento empírico de la enfermedad inflamatoria pélvica

Pelvic inflammatory disease (PID) is a clinical syndrome that encompasses upper genital tract infection (uterus, fallopian tubes, and ovaries), including any combination of endometriosis, salpingitis, pyosalpinx, oophoritis, tubular ovarian abscess, and pelvic peritonitis. A late diagnosis or inadequate treatment contribute to the development of infertility, ectopic pregnancy, and chronic pelvic pain in women. This work addresses the key principles in the treatment of this disease.

Gross and Microscopic Lesions of the Ovaries of Camels from Abattoirs in Eastern Province of Kingdom of Saudi Arabia

In the present investigation, gross and microscopic lesions of the ovaries were studied in two hundred and ten (210) adult non-pregnant she-camels. Fresh samples of ovaries were collected from she-camels at the point of slaughter in Al-Ahsa abattoir, Eastern region of Kingdom of Saudi Arabia. These samples were subjected to histopathological studies and stained by routine Hematoxylin and Eosin stain. Grossly, of the 210 ovarian tissues examined, 30 (14.28%) had ovarian lesions of one type or another, whereas 180 (85.71%) camels were apparently healthy. Only 6 (2.85%) ovaries showed unilateral ovarian hypoplasia, whereas 4 (1.9%) showed bilateral ovarian hypoplasia. Cystic ovaries were observed in a total of 13 of the collected samples of ovaries, of these 8 (3.8%) were diagnosed as follicular cystic ovaries, while 5 (2.38%) were luteal cystic ovaries. Ovarian abscess appeared in only one sample of the collected ovaries. While ovarian tumors were observed in a total of 6 of the collected samples distributed as, two fibromas, three dermoid cysts, and only one hemangioma. The present study indicates that follicular cysts, luteal cysts and ovarian hypoplasia were the most common ovarian disorders in non-pregnant she-camels in Al-Ahsa region of the Eastern Province of Kingdom of Saudi Arabia.

手術時に卵巣膿瘍の合併が判明し術後に重度の感染徴候を示した内膜症性嚢胞の１例

手術時に卵巣膿瘍の合併が判明し術後に重度の感染徴候を示した内膜症性嚢胞の１例

The Impact of Ethanol Sclerotherapy on ICSI Outcomes in Infertile Patients with Endometriomas Undergoing Controlled Ovarian Stimulation

Objective: the aim of the study was to determine whether endometrioma aspiration and alcohol sclerotherapy performed prior to controlled ovarian stimulation has any beneficial effects on ICSI outcomes in patients with endometriomas.
 Methods: The cycle characteristics and pregnancy outcomes of 103 patients with endometriomas who underwent ethanol sclerotherapy on day 2 of the controlled ovarian stimulation with a gonadotropin antagonist protocol were retrospectively compared with the cycle characteristics of 405 patients with endometriomas who did not receive scleroterapy before stimulation.
 Results: No statistically significant difference was observed in the number of retrieved oocytes, metaphase II oocytes, fertilization and good quality embryo rates between the two groups. The clinical pregnancy rate, implantation rate and live birth rates were similar among the two groups. No major complications including intraperitoneal haemorrhage, peritonitis, ovarian abscess or intestinal perforation were recorded.
 Conclusion: The results of the present study indicate that ethanol sclerotherapy does not improve ICSI outcomes when performed right before ovarian stimulation and without concomittant GnRH analogue administration. Since it is a simple outpatient procedure without significant complications, ethanol sclerotherapy may be performed prior to IVF as an alternative to surgery to improve the accessibility of follicles and monitoring of follicle growth in patients with large endometriomas and for those patients with intractable pain symptoms, without decreasing the ovarian reserve.

Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature

BackgroundOvarian abscesses, which occur mostly in sexually active women via recurrent salpingitis, occur rarely in virginal adolescent girls. Here, we present a case of an ovarian abscess in a virginal adolescent girl who was diagnosed and treated by laparoscopy.Case presentationA 13-year-old healthy girl presented with fever lasting for a month without abdominal pain. Computed tomography scan and magnetic resonance imaging indicated a right ovarian abscess. Laparoscopic surgery revealed a right ovarian abscess with intact uterus and fallopian tubes. The abscess was caused by Staphylococcus aureus. The patient recovered completely after excision of the abscess, followed by antibiotic treatment.ConclusionsOvarian abscess may occur in virginal adolescent girls; Staphylococcus aureus, an uncommon species causing ovarian abscess, may cause the infection.

Safety of in-vitro fertilization in women with endometriosis.

Management of women with endometriosis in general is complex. It requires a multidisciplinary and tailored approach. The time of in-vitro fertilization (IVF) may be particularly complicated because women with the disease face peculiar additional risks. In particular, oocytes retrieval may be more difficult and women with endometriomas are exposed to a low but consistent risk of infection and ovarian abscess development. There are also concerns regarding progression of deep invasive peritoneal lesions and misdiagnosis of an occult early ovarian cancer. However, evidence on these latter points is more controversial. Taken together, this body evidence is generally reassuring and does not justify prophylactic surgery prior to IVF to shrink these risks. However, given the uncertainties, women with endometriosis must be informed in depth of these peculiar additional risks.

Ovarian abscess rupture after oocyte retrieval in a patient with endometrioma: case report

Ovarian abscess rupture after oocyte retrieval in a patient with endometrioma: case report

Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study

BackgroundThe aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with endometriosis (EM) and tube ovarian abscess (TOA) to determine the possible association between TOA and EM.MethodsMedical records were used to analyze the clinical characteristics, treatment and complications. Twenty women who were diagnosed with TOA with EM were compared with 93 women diagnosed as having TOA without EM between January, 2008 and December, 2018.ResultsIn this study, TOA patients with EM were significantly more likely to have a lower age range (20–39 years) than the non-EM group [11/20 (55.0%) vs 27/93 (29.0%)]. In addition, TOA patients with EM were associated with a significantly lower rate of parity [11/20 (55.0%) vs 75/93 (80.6%)], higher rates of infertility [8/20(40%) vs 0/93(0%)] and a significantly lower incidence of elevated blood platelet counts [5/20 (25%) vs 43/93 (46.2%)]. Furthermore, women with EM had greater blood loss (347 ± 445.77 vs 204.67 ± 289.46) and an increased complication rate [3/20(15%) vs 0/93(0%)]. Among the 3 patients who had complications in the EM group, 2 patients had septic shock and 1 patient had intestinal obstruction. And 1 case who had septic shock followed by IVF treatment. There was no significance difference on other factors.ConclusionsThe present study indicated that EM did not increase the difficulty and time of treatment in patients with TOA, but increased bleeding during surgery and serious complications. It is suggested that doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a history of recent infertility treatment and related procedures.

Postoperative Infections in Gynecology and Obstetric

The postoperative infections is the common surgical complication in department of Gynecology and Obstetric. The degree of wound contamination and the classification of surgical site infections at the time of surgery plays an important role. The use of antibiotic prophylaxis has significantly decreased but not completely eliminated this undesirable result. Broad spectrum antibiotics should be started as soon as possible upon diagnosis of postoperative infection; most patients respond to treatment within 24 to 48 hours when appropriate antibiotics are selected. Postoperative infections include the vaginal cuff cellulitus, pelvic cellulitus, adnexal infection, ovarian abscess, pelvic abscess, abdominal incision infection and toxic shock syndrome and they are the head of our study.

124 Effect of transvaginal oocyte aspiration on equine blood and peritoneal fluid parameters

Transvaginal aspiration of oocytes (TVA) in the equine industry has gained more relevance and become a valuable technique to produce offspring from subfertile mares. TVA is a semi-invasive procedure and requires handling the ovaries transrectally to position them closely to an ultrasound probe located in the mare’s vagina. Once the ovary lies in close apposition to the ultrasound probe, a 12G needle is inserted through the needle guide, puncturing, aspirating, and scraping each follicle to recover the oocyte. Potential complications described include rectal tears, puncturing of blood vessels, ovarian abscesses, and peritonitis. Occasionally, problems occur after uneventful procedures, such as colic, peritonitis, pain, and anorexia. However, the source of these complications is not fully known. We hypothesize that blood and peritoneal fluid parameters would differ pre- and post-TVA in mares. A few reports provide some parameters after TVA (e.g. peritoneal protein, neutrophils, nucleated cells) without reference to pre-TVA values. These studies have not identified an effect in peritoneal fluid variables due to multiple abdominocenteses. Therefore, our aim was to analyse blood and peritoneal fluid in mares pre- and post-TVA, and to identify changes in parameters of the procedure (duration, number of pokes, number of follicles) and the mares’ clinical responses. Ten healthy mares were selected to undergo the procedure. Thirty minutes before starting TVA, a blood sample was drawn for complete blood count (CBC) and blood chemistry, and abdominocentesis was performed to obtain abdominal fluid and assess the cytology. This same protocol was repeated 24 hours after TVA. Physical exams were performed pre- and post-TVA. Paired t-tests were used to identify differences between groups (pre- and post-TVA). Spearman correlations (ρ) were used to assess the relationship between variables. There was a significant increase in peritoneal lactate (5.65-fold), peritoneal total protein (2.4-fold), and total nucleated cells (46-fold) between pre- and post-samples. These parameters were not associated with operator, number of times the needle was introduced into the ovaries, or number of aspirated follicles. The remaining parameters evaluated in CBC and blood chemistry did not differ. A positive correlation between total peritoneal protein and blood albumin was found post-TVA (ρ=0.72, P=0.01) but not pre-TVA (ρ=−0.1, P=0.65), suggesting an increase in protein level due to bleeding. Clinically, 9 mares were healthy throughout the study except one that presented signs of pain (facial grimace, anorexia, hyperthermia) the day following TVA. In conclusion, we showed changes in the peritoneal fluid during uneventful TVA procedures. The information provided by this research gives further insight into changes potentially caused by a TVA in abdominal fluid parameters. Further studies are necessary to determine expected standards and the duration of the changes after TVA.