Epidemiology, clinical manifestations, and diagnosis of tubo-ovarian abscess
- Richard H Beigi, MD, MSc
Richard H Beigi, MD, MSc
- Associate Professor of Reproductive Sciences
- Magee-Womens Hospital of the University of Pittsburgh Medical Center
- Section Editors
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
A tubo-ovarian abscess is an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs (eg, bowel, bladder) . This may manifest as a tubo-ovarian complex (an agglutination of those structures) or a collection of pus (tubo-ovarian abscess). These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. Tubo-ovarian abscess is usually a complication of pelvic inflammatory disease.
Tubo-ovarian abscess is a serious and potentially life-threatening condition. Aggressive medical and/or surgical therapy is required and rupture of an abscess may result in sepsis. The mortality rate associated with tubo-ovarian abscess was approximately 50 percent or higher prior to the advent of broad-spectrum antibiotics and modern surgical practice [2,3].
In current practice, the mortality rate approaches zero for abscesses that have not ruptured. Current mortality rates for patients with ruptured abscesses are not reported in the literature; data from the 1960s suggested a mortality rate ranging from 1.7 to 3.7 percent [2,4,5].
Treatment modalities include broad spectrum antibiotic therapy, minimally-invasive drainage procedures, invasive surgery, or combinations of these interventions. For the large majority of small to medium sized tubo-ovarian abscesses, antibiotic therapy alone can affect cure.
The epidemiology, clinical manifestations, and diagnosis of tubo-ovarian abscesses are reviewed here. Other manifestations of pelvic inflammatory disease (PID) are discussed separately. (See "Pelvic inflammatory disease: Pathogenesis, microbiology, and risk factors" and "Pelvic inflammatory disease: Clinical manifestations and diagnosis" and "Pelvic inflammatory disease: Treatment" and "Long-term complications of pelvic inflammatory disease".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY AND RISK FACTORS
- Progression of infection
- CLINICAL PRESENTATION
- Typical presentation
- Ruptured abscess
- EVALUATION OF WOMEN WITH SUSPECTED TOA
- Establishing a diagnosis of PID
- Further evaluation for TOA
- - Laboratory evaluation
- - Imaging studies
- - Surgical evaluation
- DIFFERENTIAL DIAGNOSIS
- FURTHER EVALUATION TO DETERMINE MANAGEMENT
- Excluding sepsis
- Determining choice of therapy
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS