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".)
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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
- SUMMARY AND RECOMMENDATIONS