Treatment Of Tubo-ovarian Abscess Research Articles

Image-guided drainage management of tubo-ovarian abscess and the role of C-reactive protein measurements in monitoring treatment response: a single-center experience.

We aimed to compare the results of image-guided drainage in addition to antibiotic therapy (antibiotherapy) with antibiotherapy alone in the treatment of tubo-ovarian abscesses (TOAs) and evaluate C-reactive protein (CRP) levels in predicting the success of antibiotherapy. This was a retrospective study of 194 patients hospitalized with TOA. Patients were divided into the following two groups: those who underwent image-guided drainage in addition to parenteral antibiotherapy and those who did not undergo image-guided drainage and received antibiotherapy alone. CRP levels on the day of admission (day 0), day 4 of hospitalization (day 4), and day of discharge (last day) were recorded. The percentage of decrease in CRP levels during day 4 and the last day compared with that on day 0 was calculated. A total of 106 patients (54.6%) underwent image-guided drainage with antibiotherapy, whereas 88 patients (45.4%) did not undergo drainage and received antibiotherapy alone. At admission, the mean CRP level was 203.4 (± 96.7)mg/L and was similar in both groups. The mean decrease in the CRP level on day 4 compared with that on day 0 was 48.5% and was statistically higher in the group that underwent image-guided drainage. Antibiotherapy failed in 18 patients, and a statistically significant difference was observed between treatment failure and the rate of decrease in the CRP level on day 4 compared with that on day 0. According to the receiver operating characteristic (ROC) analysis, if the CRP level measured on day 4 decreased by < 37.1% compared with that on day 0, the probability of treatment failure would increase (area under the curve = 0.755; 95% confidence interval, 0.668-0.841; sensitivity, 73.6%; specificity, 60%). Image-guided drainage combined with antibiotherapy in the treatment of TOA has high success rates, lower recurrence rates, and lower surgical requirement, and the mean decrease in the CRP level on day 4 can be monitored at treatment follow-up. In patients receiving antibiotherapy alone, if the CRP level on day 4 decreases by < 37.1%, the treatment protocol should be changed.

Современные направления диагностики и лечения тубоовариальных абсцессов

Раннее начало хирургического лечения у пациенток репродуктивного возраста с тубоовариальным абсцессом является основным принципом в комплексном лечении. С 2008 по 2021 г. количество хирургических ларапоскопических операций увеличивалось, а лапаротомных операций – уменьшалось. Так, оперативное лечение проведено у 64% пациенток с тубоовариальным абсцессом: лапаротомным доступом – 52,1%, лапароскопическим – 47,9%. Early initiation of surgical treatment in patients of reproductive age with tuboovarianabscess is the main method in complex treatment. From 2008 to 2021, the number of surgical laparoscopic operations increased, and laparotomy operations decreased. Thus, surgical treatment was performed in 64% of patients with tuboovarian abscess: laparotomic access – 52.1%, laparoscopic – 47.9%.

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.

Comparison of Ultrasound-Guided Drainage with Other Available Treatment Modalities for, Treatment of Tubo-Ovarian Abscess

Objective: The present study aimed at the retrospective evaluation of the medical records of patients treated for tubo-ovarian abscess (TOA) at our clinic and investigation of the efficacy of USG-guided drainage compared with that of other available treatment modalities. Material and Methods: Medical records of 100 patients with TOA, who were treated and followed up at the Department of Gynecology and Obstetrics, School of Medicine, Dicle University between January 2009 and April 2015, were reviewed retrospectively. Details such as demographic data, risk factors, clinical and laboratory findings, treatment modalities used, and complications observed were recorded for each patient. Results: The mean age of the patients was 36.46±11.6 years. Of the 100 patients, 10 were menopausal women. Pelvic pain was the most common complaint in all patients (100%). The history of intrauterine or intra-abdominal intervention within six months was the most common risk factor (60.5% patients) for the development of TOA. Of the patients, 25% reported fever (≥38 °C), 55% had leukocytosis, 85% had high sedimentation rate, and 92% had high CRP levels. The development of leukocytosis was not observed to be associated with the treatment modality used (p > 0.05). Of the patients, 38% underwent only medical treatment, 47% underwent medical treatment followed by surgery, and 15% underwent medical treatment followed by USGguided drainage. All 34 (72.3%) patients who had undergone surgical treatment required fertilitypreserving surgery. Intraoperative bowel injury (6.3% patients) and wound site infection (8.5% patients) were among the common complications reported in patients undergoing surgical treatment. The mean duration of hospital stay was 7.9¡À6 days. The longest mean duration of hospital stay (10.5±3.9 days) was observed in the patients who had undergone USG-guided drainage. Conclusion: Broad-spectrum antibiotic therapy, the first step of treatment in patients with TOA, increases the size of abscess. In addition, a significant number of patients with bilateral abscesses require additional intervention (surgery). Our findings suggest that USG-guided drainage should be considered only in patients not responding to medical treatment and not consenting to undergo surgical treatment.

Different Surgical Techniques in Tubo-ovarian Abscess Management

Objectıve: Tubo-ovarian abscess is mostly a consequence of pelvic inflammatory disease. We aimed to compare success of the different surgical methods in tubo-ovarian abscess treatment.Study Design: 53 patients with Tubo-ovarian abscess that were hospitalized and operated in the Department of Obstetrics and Gynecology at Kanuni Sultan Suleyman Training and Research Hospital during one year were included. Patients who had underwent salpingectomy/salpingo-oophorectomy and only abscess drainage were compared.Results: Salpingectomy/salpingo-oophorectomy had been done in 74.5% of cases and only drainage had been applied in 25.5% of cases. Difference in mean values between 2 groups were not observed except white blood cell count. Conclusıon: Treatment of Tubo-ovarian abscess must be a combination of parenteral antibiotics and early surgical procedure to prevent poor outcomes. There is not any difference between different surgical techniques. But additionally more studies are needed to better understand which operation technique is more effective and less complicated.

Transvaginal Ultrasound-Guided Aspiration for Treatment of Tubo-Ovarian Abscess: A Study of 302 Cases

Transvaginal Ultrasound-Guided Aspiration for Treatment of Tubo-Ovarian Abscess: A Study of 302 Cases

Laparoscopic treatment of tubo-ovarian abscess and perforation of appendix resulting from a displaced IUD

Laparoscopic treatment of tubo-ovarian abscess and perforation of appendix resulting from a displaced IUD

Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess

Objective: Our purpose was to determine the clinical effectiveness and cost-effectiveness of three antibiotic regimens for the treatment of pelvic inflammatory disease and tuboovarian abscess. Study Design: A review of all patients' hospitalized at Hutzel Hospital, Detroit, Michigan, for treatment of pelvic inflammatory disease and tuboovarian abscess between Jan. 1, 1993, and April 30, 1997, was performed. Demographic data, antibiotic choices, changes in therapy, operative interventions, and cost of therapy were assessed. Results: Two hundred three patients were admitted for treatment of pelvic inflammatory disease during the study period. We were able to evaluate the clinical efficacy of antibiotic treatment in 179 patients, including 105 patients with pelvic inflammatory disease alone (uncomplicated pelvic inflammatory disease) and 74 women whose infection was complicated by tuboovarian abscess. The three antibiotic regimens evaluated were cefotetan plus doxycycline, clindamycin plus gentamicin, and ampicillin plus clindamycin plus gentamicin. All regimens demonstrated comparable efficacy in treating uncomplicated genital tract infections. Ampicillin plus clindamycin plus gentamicin was significantly better than clindamycin plus gentamicin and cefotetan plus doxycycline in treatment of tuboovarian abscess ( p = 0.001). Fifteen women with tuboovarian abscess responded to a change to ampicillin plus gentamicin plus clindamycin antibiotic therapy alone. The hospital stay was prolonged by approximately 3 days in women failing to respond to initial antibiotic therapy, and operative interventions were common in this group of patients. Conclusions: Cefotetan plus oral doxycycline is the most cost-effective regimen for treating uncomplicated pelvic inflammatory disease, whereas triple-antibiotic therapy is the treatment of choice in women with tuboovarian abscess. (Am J Obstet Gynecol 1998;178:1272-8.)

Progress in the management of tuboovarian abscesses.

The last 20 years have witnessed remarkable improvements in the treatment of tuboovarian abscesses. Gone are the days of significant mortality associated with ruptured and unruptured TOAs. Broad-spectrum antibiotics have enabled patients to be treated solely with medical therapy, avoiding the need for surgery. Operative intervention is still necessary in 25% of cases of unruptured TOAs, but the combination of conservative surgical procedures, such as unilateral salpingo-oophorectomy, and broad-spectrum antimicrobial agent therapy have reduced the need for total abdominal hysterectomy with bilateral salpingo-oophorectomy greatly. Although fertility after TOAs is compromised significantly, new advances in reproductive technology, including in vitro fertilization and donor egg transplantation, represent reproductive options for these women. Percutaneous drainage and laparoscopic treatment of TOAs are becoming popular treatment options, but prospective studies urgently are needed to assess their efficacy.

Pelvic inflammatory disease

Pelvic inflammatory disease is a common serious complication of the sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis. There are more than 800,000 cases of pelvic inflammatory disease annually accounting for approximately 200,000 hospital admissions for acute and chronic infections. Early accurate diagnosis and treatment are essential to prevent the serious sequelae including ectopic pregnancy, tubal disease infertility, chronic pain, and disability requiring multiple hospitalizations and surgery. Although clinical models to aid in the diagnosis and management of pelvic inflammatory disease have been developed by numerous investigators, all have lacked the sensitivity and specificity to be helpful to the clinician. Laparoscopy, considered by many to be the "gold standard" for diagnosis, is underutilized, and the definition of pelvic infection differs between investigators. Improved patient compliance and safety may be seen if single-agent therapy for acute pelvic inflammatory disease becomes a reality. In a small prospective randomized study, oral ofloxacin was as effective as cefoxitin plus doxycycline for outpatient treatment of chlamydial and gonococcal pelvic inflammatory disease. Treatment of tuboovarian abscess appears to be successful with single agent and combination therapy. Risk factors for developing postabortion endometritis continue to be identified, and the most efficacious prophylactic antibiotic regimen has not been determined to date.

Transvaginal Ultrasound in the Diagnosis and Treatment of Tubo-ovarian Abscess

Transvaginal ultrasound showed tubo-ovarian abscess in 10 patients admitted for acute pelvic inflammatory disease, and transvaginal ultrasound-guided aspiration of tubo-ovarian abscess was performed under antimicrobial treatment. Only light sedation was required and the procedure was well tolerated by the patients. The short-term recovery of all patients was quick and uncomplicated. This new technique is a useful alternative for the diagnosis and treatment of tubo-ovarian abscess.

Transvaginal ultrasound in the diagnosis and treatment of tubo‐ovarian abscess

Transvaginal ultrasound showed tubo-ovarian abscess in 10 patients admitted for acute pelvic inflammatory disease, and transvaginal ultrasound-guided aspiration of tubo-ovarian abscess was performed under antimicrobial treatment. Only light sedation was required and the procedure was well tolerated by the patients. The short-term recovery of all patients was quick and uncomplicated. This new technique is a useful alternative for the diagnosis and treatment of tubo-ovarian abscess.

Laparoscopic treatment of tubo-ovarian abscesses

Laparoscopic treatment of tubo-ovarian abscesses

Current trends in the diagnosis and treatment of tuboovarian abscess

Tuboovarian abscess is a well-recognized complication of acute salpingitis and has been reported in as many as one third of hospital admissions for acute salpingitis. The incidence of tuboovarian abscess is expected to increase as a result of the current epidemic of sexually transmitted diseases and their sequelae. Patients with tuboovarian abscess most commonly present with lower abdominal pain and an adnexal mass(es). Fever and leukocytosis may be absent. Ultrasound, computed tomographic scans, laparoscopy, or laparotomy may be necessary to confirm the diagnosis. Tuboovarian abscess may be unilateral or bilateral regardless of intrauterine contraceptive device usage. Tuboovarian abscess is polymicrobial with a preponderance of anaerobic organisms. An initial conservative antimicrobial approach to the management of the unruptured tuboovarian abscess is appropriate if the antimicrobial agents used can penetrate abscesses, remain active within the abscess environment, and are active against the major pathogens in tuboovarian abscess, including the resistant gram-negative anaerobes such as Bacteroides fragilis and Bacteroides bivius. However, if the patient does not begin to show a response within a reasonable amount of time, about 48 to 72 hours, surgical intervention should be undertaken. Suspicion of rupture should remain an indication for immediate operation. Once operation is undertaken, a conservative approach with unilateral adnexectomy for one-side tuboovarian abscess is appropriate if future fertility or hormone production is desired.