Management and complications 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 (TOA) is an inflammatory mass involving the fallopian tube, ovary and, occasionally, other adjacent pelvic organs (eg, bowel, bladder) . These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection.
TOA 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. Prior to the advent of broad-spectrum antibiotics and modern surgical practice, the mortality rate associated with TOA was approximately 50 percent or higher [2,3].
The mortality rate approaches zero for abscesses that are not ruptured. For patients with ruptured abscesses, current mortality rates have not been reported, but data from the 1960s suggest the rate may be as high as 1.7 to 3.7 percent [2,4,5].
Treatment modalities for TOA include intensive antibiotic therapy, minimally-invasive drainage procedures, invasive surgery, or a combination of these interventions. The large majority of small abscesses (<9 cm in diameter) resolves with antibiotic therapy alone.
The management of tubo-ovarian abscesses is reviewed here. The epidemiology, diagnosis and evaluation of tubo-ovarian abscesses are discussed separately. Other manifestations of pelvic inflammatory disease are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of tubo-ovarian abscess" and "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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- CHOOSING A MANAGEMENT APPROACH
- Indications for immediate surgery
- Candidates for antibiotic therapy alone
- - Women who fail antibiotic therapy
- Treatment of sexual partners
- Antibiotic therapy
- - Antibiotic regimens
- Actinomyces or rare pathogens
- - Monitoring therapy
- - Duration of therapy
- Minimally-invasive drainage procedures
- - Procedure
- Abscess rupture
- SPECIAL CLINICAL ISSUES
- Intrauterine devices
- Postmenopausal women
- Pregnant women
- SUMMARY AND RECOMMENDATIONS