Tubo-Ovarian Abscess

Introduction

• Description: Tubo-ovarian abscess is an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs. These abscesses most often occur as a complication of pelvic inflammatory disease (PID), though spread from other sites is possible. Rupture of a tubo-ovarian abscess (15% of cases) represents a life-threatening surgical emergency. The presence of active infection differentiates tubo-ovarian abscesses from a sterile hydrosalpinx.

• Prevalence: Roughly 30%–40% of patients hospitalized for PID have a tubo-ovarian abscess.

• Predominant Age: Reproductive age; most common age 15–40 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Infection of the fallopian tube by ascending infection from sexually transmitted infections or vaginal flora. Less frequently, abscesses can form as secondary infections from gastrointestinal sources (inflammatory bowel disease, appendicitis), adnexal surgery, or hematologic spread.

• Risk Factors: Multiple sexual partners, prior history of PID, uterine or cervical instrumentation, douching. Well-designed studies indicate that intrauterine contraceptive devices are not a risk factor for abscess, though they are associated with a slightly increased risk of pelvic infection during the first 3 weeks following insertion.

Signs and Symptoms

• Adnexal fullness and tenderness in the setting of a clinical diagnosis of PID

• Pelvic pain and tenderness (may be acute or indolent), muscular guarding, or rebound tenderness

• Fever (up to 39.5°C, 40%) or chills; may not be present (40%)

• Tachycardia, nausea, and vomiting

• Elevated white blood cell (WBC) count (in 25% of cases the WBC count is normal)

• Irregular vaginal bleeding or discharge

• Purulent cervical discharge may be present in PID but is not specific or required for the diagnosis of tubo-ovarian abscess

Diagnostic Approach