tubo-ovarian abscess (TOA)

Question 1

Tubo-ovarian abscess pathogenesis :

Answer 1

accumulation of pus in the adnexa -forming an inflammatory mass involving the
oviducts, ovaries, uterus, or omentum.

• usually polymicrobial

Question 2

Tubo-ovarian abscess on examination

Answer 2

*The patient will look septic, ill
*she may be in septic shock with hypotension.
*Lower abdominal-pelvic pain is severe
* high fever with tachycardia.
Abdominal examination shows peritoneal signs, guarding, and rigidity.
*Bilateral adnexal masses may be palpated

Question 3

Investigative findings

Answer 3

*positive cervical cultures for chlamydia or gonorrhea.
*WBC and ESR are markedly elevated.
*Sonography or CT scan will show bilateral complex pelvic masses

Question 4

Tubo-ovarian abscess risk factors

Answer 4

• multiple sexual partners
  *age between 15-25
  prior history of PID

Question 5

Management
for TOA (initial )

Answer 5

*Always Inpatient:
** IV clindamycin and gentamicin
**should result in fever subside within 72 hours.

Question 6

If there is no response or there is rupture of the
abscess exposing free pus into the peritoneal
cavity, . what to do ?

Answer 6

significant mortality can occur

**so percutaneous drainage may be required.(ultrasound guided or CT)
* Or Exploratory laparotomy with possible TAH and
BSO