Tubo-ovarian Abscess Research Articles

Gonococcal Infections

Gonococcal Infections

Gonococcal Infections

Gonococcal Infections

Neonatal pneumococcal sepsis associated with maternal tubo-ovarian abscess

Streptococcus (S.) pneumoniae is a Gram-positive, alpha-haemolytic bacterium. This organism was identified at the end of the 19th century as a commensal bacterium of the upper respiratory tract. It...

Tuboovarian Abscess Caused by Hydatid Cyst: A Rare Case

Primary lesions of hydatid cysts caused by Echinococcus granulosus, are frequently localized in liver, followed by lungs, muscles, kidneys, spleen and bones. Pelvic inoculations are rare and usually occur as a secondary infection. In this report, a case of primary hydatid cyst in the abdomen, spleen and pelvic organs, clinically mimicking tuboovarian abscess, was presented. A nineteen-years-old female patient was admitted to the gynecology outpatient clinic with the complaint of abdominal pain for two days. The case was considered as tuboovarian abscess according to the initial examination findings and hospitalized for treatment and follow-up. In transabdominal ultrasound examination, 44 x 43 mm thin-walled septated cysts in the left ovary and 65 x 65 mm thin-walled multiloculated cysts in the spleen were detected. Abdominal computerized tomography also yielded multivesicular cystic masses in spleen, front abdominal wall and the left ovary. Since the clinical and vital findings worsened, she initially underwent ovarian cystectomy by laparoscopy, then abdominal cystectomy and splenectomy. The operation material examined macroscopically was compatible with hydatid cyst with the characteristics of a germinative membrane and hydatid sand. The diagnosis was confirmed by histopathological examination. The patient was discharged without complication on post-operative sixth day, with a recommendation of albendezol (15 mg/kg/day, 3 months) treatment. Since the patient had undergone emergency surgery, indirect hemaglutination (IHA) test had not been performed pre-operatively. However, post-operative third month serum sample revealed a positive (1/32) IHA titer. In conclusion, hydatid cyst should be kept in mind in the differential diagnosis of patients with abdominal pain, in response to the high prevalence of the parasite in our country.

Evaluating the risk factors for developing resistance to parenteral therapy for tubo‐ovarian abscess: A case–control study

The aim of this study was to identify factors that can predict the resistance to parenteral therapy in patients with tubo-ovarian abscesses (TOA). We conducted a case-control study involving 55 admitted patients with TOA. The subjects eligible for this study included 28 patients who failed antibiotic therapy and required surgery (surgical cases) and 27 patients who were conservatively cured (control cases). The clinical characteristics of the patients on admission were reviewed. Logistic regression analysis was performed after univariate analysis to identify potentially important variables and to calculate odds ratios with 95% confidence intervals. As per the univariate analysis, compared to the control cases, the surgical cases were older (40.4 vs 31.5 years), had higher white blood cell counts (14000 vs 11828 cells/mm³), higher C-reactive protein levels (16.1 vs 7.6 mg/dL), and a larger abscess diameter (6.6 vs 3.9 cm). There were no significant differences in gravidity, parity, body temperature, rate of endometrial cyst formation, and Chlamydia trachomatis infection rates between the groups. Multiple logistic regression analysis indicated that the only statistically significant risk factor predicting parenteral antibiotic therapy failure was the abscess diameter >5 cm (odds ratio = 69.6; 95% confidence interval = 9.3-527, P < 0.0001). An abscess diameter >5 cm is an important factor for predicting the failure of antibiotic therapy in patients with TOA. Moreover, it is useful for determining whether patients with TOA should be surgically treated.

Using the Tracheobronchial Stent to Achieve Vaginal Patency After Repeated Failed Attempts in a Patient With OHVIRA

OHVIRA syndrome (obstructed hemivagina and ipsilateral renal agenesis) also known as Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare Mullerian duct anomaly. Surgical management can be difficult, especially if the level of obstruction is high, and there is a chance of re-obstruction requiring further surgical procedures. Successful use of a tracheobronchial stent to maintain vaginal patency has been previously described in a patient with OHVIRA undergoing a primary procedure.1 However, this is the first reported case of successfully achieving vaginal patency with the tracheobronchial stent in a patient with OHIVRA who had previously re-obstructed twice. A 13 year-old G0 female presented to the E.R. with a chief complaint of increasing intermittent lower abdominal and low back pain for the past few months. Patient had menarche at age 11 with normal cyclic menses lasting 5-7 days. On exam, a moderately sized palpable mass was noted 4 cm below her umbilicus. Pelvic ultrasound revealed an 11x7x9cm mass and the CT scan identified an absent left kidney, marked left hematosalpinx, uterine didelphys and left hematometrocolpos. The patient underwent resection and marsupialization of the left vaginal septum with evacuation of the hematometrocolpos. However, 3 weeks postoperatively, she developed significant lower abdominal pain and low-grade fever with leukocytosis. Imaging at that time suggested a tubo-ovarian abscess as a cause of her symptoms. She then underwent a laparoscopy, which was converted to a laparotomy when it was discovered she had a 10cm left tubo-ovarian abscess and complete re-obstruction of her left vagina. A left salpingo-oophorectomy and reopening of the left vaginal cuff with placement of a 24 French foley catheter was performed. The catheter was kept in place for 6 weeks and then removed in the office. Two weeks after removal, patient developed lower abdominal pain and imaging showed a 2.5 cm hematometra. Patient underwent re-opening of her obstructed left vagina and an 18x40mm AERO tracheobronchial stent was placed. Two months later, the stent was removed. One-year after removal of the stent, she is having normal menses, no pain and no evidence of re-obstruction. Obstructed hemivagina and ipsilateral renal agenesis(OHVIRA) constitutes about 0.16-10% of all Mullerian anomalies.2 The arrest of the ipsilateral mesonephric duct at 8 weeks of gestation is the believed to be the cause of the obstructed hemivagina.2 The mean age of presentation is 14 years and patients typically present with vague symptoms such as dysmenorrhea, abdominal pain and occasionally a pelvic mass. Initial management with imaging such as ultrasonography can help aid in diagnosis of OHVIRA. A retrospective case series of 27 patients concluded that OHVIRA syndrome can be surgically management solely with single-stage vaginoplasty.3 However, complications such as vaginal stenosis can arise especially if the level of obstruction is high in the vagina. This case demonstrates that tracheobronchial stents can be successful in achieving vaginal patency in patients who have failed their primary vaginoplasty. 1.Cooper, Amber and Merritt, Diane F. “Novel use of a tracheobronchial stent in a patient with uterine didelphys and obstructed hemivagina.” Fertility and Sterility. 93(3). 2010 900-03. Print2.Cox, Deven, and Ching, Brian."Herlyn-Werner-Wunderlich syndrome: a rare presentation with pyocolpos." Radiology Case. 6.3 (2012): 9-15. Print.3.Smith, Nicole and Laufer, Marc. “ Obstructed hemivagina and ipsilateral renal anomaly(OHVIRA) syndrome: management and follow up.” Fertility and Sterility. 87(4). 2007. 918-22. Print

Term delivery following tuboovarian abscess after in vitro fertilization and embryo transfer

A tuboovarian abscess (TOA) during pregnancy following oocyte retrieval is extremely rare. We report a rare case of pregnancy complicated by the development of a TOA following in vitro fertilization-embryo transfer that was treated successfully with laparoscopy. We also review all similar cases reported in the English-language literature.

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.

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.

Tuberculosis of the Female Breast and Reproductive Organs: A Diagnostic Dilemma

Background: Tuberculosis is prevalent in developing countries and extra-pulmonary involvement is now a frequent manifestation. However, involvement of the breast and reproductive organs in females is a cause of diagnostic confusion due to the non- specific nature of presenting symptoms which may simulate malignant disease processes. Materials and methods: All females with histological confirmation of tuberculosis involving the breast and reproductive organs were analyzed over a 16 year period. Tissue biopsies were fixed in formalin, processed in paraffin and stained with haematoxylin & eosin and Ziehl Neelsen stain to identify the acid fast bacilli of mycobacterium tuberculosis. Results: 28 females are presented and their ages ranged from 14 to 52 years with a mean age of 29.3. Presenting symptoms were varied and included abdominal/pelvic pain, abdominal swelling, post coital bleeding, vaginal bleeding and discharge, amenorrhoea and infertility while four females presented with breast mass and pain. Duration of symptoms was from one month to 5 years. Clinical diagnosis included dermoid cyst, tubo-ovarian abscess, leaking ectopic gestation, malignant ovarian tumour, fibroadenoma and breast cancer. Eighteen of the females had laparotomy, four had endometrial curettage, another four had excision biopsy/lumpectomy and two had cervical punch biopsy. Only the four females with breast lesions had fine needle aspiration biopsy prior to tissue biopsy. Also, one female was HIV positive and on anti-retroviral drugs. Microscopy of tissue biopsies from the breast, ovary, fallopian tubes, endometrium and cervix revealed granulomata, multinucleated langhan type giant cells and extensive caesation. Conclusion: Tuberculosis may mimic malignant lesions of the breast, ovary and cervix due to the absence of specific diagnostic symptoms and should be a differential diagnosis in breast and gynaecological diseases in reproductive age females. In resource limited setting, early diagnosis by fine needle aspiration technique and tissue histology may reduce attendant morbidity, irreversible sterility and also prevent unnecessary surgery in patients.

Laparoscopic treatment of tubo-ovarian abscess with deep endometriosis, a case report

Laparoscopic treatment of tubo-ovarian abscess with deep endometriosis, a case report

A vaginal drain of a pelvic abscess due to colonic diverticulitis

Although well recognized for tubo-ovarian abscesses, we report, in our best knowledge, the first case of a vaginal drain of a pelvic abscess due to colonic diverticulitis. A 78-year-old patient presented with abdominal and pelvic pain, fever (39.3 °C) and an elevated white blood cell count (18500/mL). After abdominopelvic computed tomography the patient was presumed to have a pelvic abscess, which developed as a complication of the sigmoid diverticulitis. Due to the numerous intervening structures that create obstacles to safe percutaneous access, we planned a trans-vaginal drain. A rapid recovery was obtained within 2 d from the procedure and, at present, the follow-up was uneventful after 18 mo. We believe that transvaginal drain of pelvic abscess could be a useful alternative, when percutaneous approach is not feasible.

Primary Bilateral Fallopian Tube Carcinoma The Report of a Single Case with Review of the Literature

Primary fallopian tube carcinoma is an extremely uncommon neoplasm of the female genital tract. Primary Fallopian Tube Carcinoma (PFTC) has a clinical and a histological resemblance to Epithelial Ovarian Cancer (EOC). We are reporting a case of PFTC in a 55 year old tubectomized, postmenopausal woman with the non-specific complaints of a watery vaginal discharge and lower abdominal pain. The clinical and radiological findings suggested a bilateral tubo-ovarian abscess. On laprotomy, a bilateral fallopian tube tumour was seen, with a focal extension to the surface of the right ovary from the right fallopian tube. Total abdominal hysterectomy, bilateral adnexectomy andomentectomy, along with excision of the draining lymph nodes, was done. The histopathological examination revealed a bilateral papillary serous carcinoma of the fallopian tube. The patient was treated with adjuvant chemotherapy with Paclitaxel. There was no evidence of any recurrence, after 2 years of regular follow up. The clinical signs and symptoms of fallopian tube neoplasms are usually non-specific. The primary treatment remains a surgical resection, followed by adjuvant chemotherapy or radiation. The prognosis is poor, although long-term survivors have been reported.

A Case of Spontaneous Bladder Rupture Mimicking Diabetic Nephropathy in a Patient with Type 2 Diabetes Mellitus

&lt;p&gt;Spontaneous rupture of the urinary bladder is a rare clinical entity, with the incidence reported as 1 in 126,000 hospital admissions. It is often associated with malignancy, inflammatory lesions, irradiation, calculus, diverticulum, binge alcohol drinking, continuous bladder irrigation, and neurogenic bladder. In rare instances, bladder rupture occurs without obvious causes. This rare clinical condition is difficult to diagnose because of vague symptoms. High index of suspicion is needed as the mortality rate is high if untreated. A 37-year-old woman with uncontrolled type 2 diabetes, was admitted to the emergency room complaining of progressive abdominal distension and discomfort. She had a past history of tubo-ovarian and bladder abscess, and had undergone multiple surgical operations. From ascites fluid study, she was diagnosed as spontaneous bladder rupture. A transurethral catheter was inserted and the symptoms and signs resolved. Bladder rupture, mimicking acute kidney injury of diabetic nephropathy was disclosed without surgery.&lt;/p&gt;

Pathogenesis, Diagnosis, and Management of Severe Pelvic Inflammatory Disease and Tuboovarian Abscess

Severe pelvic inflammatory disease and tuboovarian abscesses (TOAs) are common pelvic infections requiring inpatient admission. There are few large randomized trials guiding appropriate clinical management of TOA, including antibiotic selection and timing of surgical management and drainage. The pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and TOA are summarized and reviewed from the most current literature.

Prise en charge des abcès tubo-ovariens

The antibiotic treatment is indispensable for the treatment of the tubo-ovarian abscesses (TOA). It has to have a wide spectre and would be secondarily adapted in case of a sexually transmitted infection. The surgery remains indicated in first intention in case of vital threat (generalized peritonitis, toxic shock). In the not complicated TOA, the evacuation of abscesses (by draining under imaging or laparoscopy) with the antibiotic treatment gives better rates of cure than the antibiotic treatment alone. For the surgery, several entrys are possible. The laparoscopy allows a shorter hospitalization with fewer complications and a faster resolution of the fever than the laparotomy. The conservative surgery, realized by laparoscopy, has hight rates of successes with few complications. The radical surgery, by coelioscopy or by laparotomy, has high rates of complications. Transvaginal ultrasound guided aspiration is an alternative in the drainage by laparscopy with identical succes. It has been well evaluated. It has low morbidity and can be proposed in first intention in not complicated TOA.

Extramedullary Hematopoiesis Involving Uterus, Fallopian Tubes, and Ovaries, Mimicking Bilateral Tuboovarian Abscesses

Extramedullary hematopoiesis (EMH) is normal during fetal life, but after birth, the presence of EMH is considered to be abnormal. The most common sites for EMH are the liver, the spleen, and paraspinal regions of the thorax; however, it has been reported to involve virtually any organ or tissue. To our knowledge, this is the first reported case of EMH involving the entire upper genital tract, including the uterus, fallopian tubes, and ovaries. A 43-yr-old African American woman presented with a tender pelvic mass and a markedly elevated white blood cell count. Imaging was consistent with bilateral tuboovarian abscesses. Laparotomy and removal of uterus, tubes, and ovaries and bone marrow biopsy confirmed chronic myelogenous leukemia in the chronic phase and EMH in the cervix, endometrium, and ovaries, and no evidence of infection. We believe this to be the first reported case of EMH involving all organs of the upper genital tract presenting in a patient who has chronic myelogenous leukemia but not in blast crisis. This case illustrates the importance of a broad differential diagnosis when managing a patient with a pelvic mass and the value of a multidisciplinary team approach.

The role of the serum inflammatory markers for predicting the tubo-ovarian abscess in acute pelvic inflammatory disease: a single-center 5-year experience

To compare patients with tubo ovarian abscess (TOA) and non-TOA acute pelvic inflammatory disease (PID) and to determinate admitted day laboratory cut-off values for the TOA. Files of inpatients admitted to our clinic with the diagnoses of PID and/or TOA between the years of 2006 and 2011. Laboratory and culture results were obtained from the database of hospital. A total of 73 patients diagnosed with PID and/or TOA were evaluated. Patients who were diagnosed with TOA and PID by physical and sonographic examination were assigned to group 1 and group 2, respectively. Both groups were compared in terms of laboratory, clinical, and epidemiological parameters. Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found. Mean age of patients was determined as 41.4 ± 7.7 in group 1 and as 35.1 ± 6.8 in group 2. Abscess was detected more frequently in patients with low socio-cultural level, and this was found to be statistically significant. The diameter of abscess was found to be ≥5 cm in 39 (88.6 %) patients and <5 cm in 5 (11.4 %) patients. The average length of hospital stay was statistically significantly increased in patients with an abscess of ≥5 cm in size compared to patients with an abscess of <5 cm. When C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte counts were statistically evaluated by ROC curves, diagnostic ability of CRP, ESR and leukocyte count was found to be 73, 87, and 58 %. CRP has a specificity of 63 % and a sensitivity of 72 % if cut-off value is considered as 11.5 mg/L whereas ESR has a specificity of 83 % and a sensitivity of 79 % if cut-off value is considered as 19.5 mm/1/2 h. ESR >19.5 mm/1/2 h and CRP >11.5 mg/L were the best predictors of TOA. The high level of CRP and ESR was associated with longer duration of hospitalization and disease severity, and these levels were statistically significantly associated with TOA size of ≥5 cm.

Post-partum, post-sterilization tubo-ovarian abscess caused by Fusobacterium necrophorum: a case report

IntroductionPost-partum, post-sterilization tubo-ovarian abscess is a rare event. Fusobacterium necrophorum subspecies funduliforme, a normal flora found mainly in the oral cavity, appears to be the etiologic organism.Case presentationIn this case report, a 25-year-old Thai woman had a post-partum, post-sterilization tubo-ovarian abscess caused by the strictly anaerobic bacterium, Fusobacterium necrophorum subspecies funduliforme. Progressively severe symptoms started 3 weeks after her third vaginal delivery with a tubal sterilization on the following day. On admission, she presented with peritonitis and impending shock. An exploratory laparotomy showed a ruptured left tubo-ovarian abscess. A segment of her ileum had to be resected because of severe inflammation.ConclusionsFusobacterium necrophorum subspecies funduliforme can be an etiologic organism of a ruptured tubo-ovarian abscess following tubal sterilization in a healthy host.

Streptococcus viridans tubo‐ovarian abscess in an adolescent virgin

A tubo-ovarian abscess (TOA) is a common complication of pelvic inflammatory disease in premenopausal women; however, in virginal females, TOAs are an exceedingly rare occurrence. Within this rare subset of patients, there is almost always an underlying condition, such as vaginal voiding, or a concomitant disease process. A virginal adolescent female with no prior medical history presented with a large pelvic mass which proved to be a TOA. An exploratory laparotomy was eventually required to establish the diagnosis. Open drainage and antibiotic therapy successfully treated the patient. With only the organism, Streptococcus viridians, isolated in her cultures, an etiology of direct ascension from the lower genitourinary tract is implicated. We believe this to be the youngest case of a TOA occurring in a virginal adolescent female without a predisposing condition. A TOA should be considered in the differential diagnosis of pelvic masses in previously healthy pediatric patients regardless of their sexual activity.