Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities.
Methods:
This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment.
Results:
Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA <5 cm. When TOA is >5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA.
Conclusions:
More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.
GranbergSGjellandKEkerhovdE.The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol2009; 23: 667–678.
2.
TaylorKJWassonJFDe GraaffC, et al. Accuracy of grey-scale ultrasound diagnosis of abdominal and pelvic abscesses in 220 patients. Lancet1978; 1: 83–84.
3.
LandersDVSweetRL.Current trends in the diagnosis and treatment of tuboovarian abscess. Am J Obstet Gynecol1985; 151: 1098–1110.
4.
ToJAldapeDFrostA, et al. Image-guided drainage versus antibiotic-only treatment of pelvic abscesses: short-term and long-term outcomes. Fertil Steril2014; 102: 1155–1159.
5.
TopcuHOKokanaliKGuzelAI, et al. Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess. J Obstet Gynaecol2015; 35: 699–702.
6.
AkkurtMOYalcinSEAkkurtI, et al. The evaluation of risk factors for failed response to conservative treatment in tuboovarian abscesses. J Turk Ger Gynecol Assoc2015; 16: 226–230.
7.
WalkerCKLandersDV.Pelvic abscesses: new trends in management. Obstet Gynaecol Surv1991; 46: 615–624.
8.
McNeeleySGHendrixSLManzoniMM, et al. Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess. Am J Obstet Gynaecol1998; 178: 1272–1278.
9.
GjellandKEkerhovdEGranbergS.Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynaecol2005; 193: 1323–1330.
10.
CohenCRMugoNRAsteteSG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect2005; 81: 463–466.
11.
WestromL.Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol1980; 138: 880–892.
12.
VargheseJCO’NeilMJGervaisDA, et al. Transvaginal catheter drainage of tuboovarian abscess using the trocar method: technique and literature review. AM J Roentgenol2001; 177: 139–144.
13.
ChappellCAWiesenfeldHC.Pathogenesis, diagnosis and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol2012; 55: 893–903.
14.
CohenCRSineiSReillyM, et al. Effect of human immunodeficiency virus type 1 infection upon acute salpingitis: a laparoscopic study. J Infect Dis1998; 178: 1352–1358.
15.
KamengaMCDe CockKMSt LouisME, et al. The impact of human immunodeficiency virus infection on pelvic inflammatory disease: a case control study in Abidjan, Ivory Coast. Am J Obstet Gynecol1995; 172: 919–925.
16.
SoperDE.Pelvic inflammatory disease. Infect Dis Clin N Am1994; 8: 821–840.
17.
YounisJSEzraYLauferN, et al. Late manifestation of pelvic abscess following oocyte retrieval, for in vitro fertilization, in patients with severe endometriosis and ovarian endometriomata. J Assist Reprod Genet1997; 14(6): 343–346.
18.
SweetRLGibbsRS.Mixed anaerobic-aerobic pelvic infection and pelvic abscess. In: SweetRLGibbsRS (eds) Infections diseases of the female genital tract. 4th ed.Philadelphia, PA: Lippincott Williams & Wilkins, 2002, pp. 176–206.
WiesenfeldHCSweetRL.Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol1993; 36: 433–444.
21.
MontagnaPCapellinoSVillaggioB, et al. Peritoneal fluid macrophages in endometriosis: correlation between the expression of estrogen receptors and inflammation. Fertil Steril2008; 90(1): 156–164.
22.
AroshJALeeJHBalasubbramanianD, et al. Molecular and preclinical basis to inhibit PGE2 receptors EP2 and EP4 as a novel nonsteroidal therapy for endometriosis. Proc Natl Acad Sci USA2015; 112(31): 9716–9721. www.pnas.org/cgi/doi/10.1073/pnas.1507931112
23.
KyamaCMMihalyiASimsaP, et al. Role of cytokines in the endometrial-peritoneal cross-talk and development of endometriosis. Front Biosci2009; 1: 444–454. http://www.ncbi.nlm.nih.gov/pubmed/19482658
VrekoussisTSiafakaVTsitouA, et al. Endometriosis-related chronic pelvic pain: a mini review on pathophysiology and impact on mental health. J Endometr Pelvic Pain Disord2020; 12(1): 35–40.
26.
EschenbachDABuchananTMPollockHM, et al. Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med1975; 293: 166–171.
27.
Timor-TritschIEMonteagudoATsymbalT, et al. Three-dimensional inversion rendering: a new sonographic technique and its use in gynecology. J Ultrasound Med2005; 24: 681–688.
28.
WilburACAizensteinRINappTE.CT findings in tuboovarian abscess. Am J Roentgenol1992; 158: 575–579.
29.
TukevaTAAronenHJKarjalainenPT, et al. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology1999; 210: 209–216.
30.
HorrowMM.Ultrasound of pelvic inflammatory disease. Ultrasound Q2004; 20: 171–179.
31.
HillerNSellaTLev-SagiA, et al. Computed tomographic features of tuboovarian abscess. J Reprod Med2005; 50: 203–208.
32.
JeongWKKimYSongSY.Tubo-ovarian abscess: CT and pathological correlation. Clin Imaging2007; 31: 414–418.
33.
KalishGMPatelMDGunnML, et al. Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. Ultrasound Q2007; 23: 167–175.
34.
DohkeMWatanabeYOkumuraA, et al. Comprehensive MR imaging of acute gynecologic diseases. Radiographics2000; 20: 1551–1566.
35.
BoardmanLAPeipertJFBrodyJM, et al. Endovaginal sonography for the diagnosis of upper genital tract infection. Obstet Gynecol1997; 90: 54–57.
36.
MoirCRobinsRE.Role of ultrasound, gallium scanning and computed tomography in the diagnosis of intraabdominal abscess. Am J Surg1982; 143: 582–585.
37.
Henry-SuchetJ.Laparoscopic treatment of tubo-ovarian abscess: thirty years’ experience. J Am Gynecol Laparosc2002; 9: 235–237.
38.
YangCCChenPTsengJY, et al. Advantages of open laparoscopic surgery over exploratory laparotomy in patients with tubo-ovarian abscess. J Am Assoc Gynecol Laparosc2002; 9: 327–332.
39.
KrivakTCCookseyCPropstAM.Tubo-ovarian abscess: diagnosis, medical and surgical management. Compr Ther2004; 30(2): 93–100.
40.
DoganayMIskenderCKilicS, et al. Treatment approaches in tubo-ovarian abscesses according to scoring system. Bratisl Lek Listy2011; 112(4): 200–203.
41.
FouksYCohenAShapiraU, et al. Surgical intervention in patients with tubo-ovarian abscess: clinical predictors and a simple risk score. J Minim Invasive Gynecol2019; 26(3): 535–543.
42.
LevinGHerzbergSDiorUP, et al. The predictive role of CA-125 in the management of tubo-ovarian abscess. A retrospective study. Eur J Obstet Gynecol Reprod Biol2019; 238: 20–24.
43.
AlayIKayaCKaracaI, et al. The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess. J Obstet Gynaecol Res2019; 45(6): 1183–1189.
DodsonMG.Antibiotic regimens for treating acute pelvic inflammatory disease. An evaluation. J Reprod Med1994; 39: 285–296.
46.
ReedSDLandersDVSweetRL.Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. Am J Obstet Gynecol1991; 164: 1556–1561; discussion 61–62.
47.
InalZOInalHAGorkemU.Experience of tubo-ovarian abscess: a retrospective clinical analysis of 318 patients in a Single Tertiary Center in Middle Turkey. Surg Infect (Larchmt)2018; 19(1): 54–60.
48.
SudakoffGSLundeenSJOttersonMF.Transrectal and transvaginal sonographic intervention of infected pelvic fluid collections: a complete approach. Ultrasound Q2005; 21: 175–185.
49.
NosherJLWinchmanHKNeedellGS.Transvaginal pelvic abscess drainage with US guidance. Radiology1987; 165: 872–873.
50.
TeisalaKHeinonenPKPunnonenR.Transvaginal ultrasound in the diagnosis and treatment of tubo-ovarian abscess. Br J Obstet Gynaecol1990; 97: 178–180.
51.
PickerRHMcLennanACRobertsonRD, et al. Conservative management of pelvic abscess in recurrent pelvic inflammatory disease. Ultrasound Obstet Gynecol1991; 1: 60–62.
52.
vanSonnenbergED’AgostinoHBCasolaG, et al. US-guided transvaginal drainage of pelvic abscesses and fluid collections. Radiology1991; 181: 53–56.
53.
FeldREschelmanDJSagermanJE, et al. Treatment of pelvic abscesses and other fluid collections: efficacy of transvaginal sonographically guided aspiration and drainage. Am J Roentgenol1994; 163: 1141–1145.
54.
AboulgharMAMansourRTSerourGI.Ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges: an optional treatment for acute pelvic inflammatory disease. Am J Obstet Gynecol1995; 172: 1501–1503.
55.
NelsonALSinowRMRensloR, et al. Endovaginal ultrasonographically guided transvaginal drainage for treatment of pelvic abscesses. Am J Obstet Gynecol1995; 172: 1926–1932.
56.
Perez-MedinaTHuertasMABajoJM.Early ultrasound-guided transvaginal drainage of tubo-ovarian abscesses: a randomized study. Ultrasound Obstet Gynecol1996; 7: 435–438.
57.
CaspiBZalelYOrY, et al. Sonographically guided aspiration: an alternative therapy for tubo-ovarian abscess. Ultrasound Obstet Gynecol1996; 7: 439–442.
58.
CorsiPJJohnsonSCGonikB, et al. Transvaginal ultrasound-guided aspiration of pelvic abscesses. Infect Dis Obstet Gynecol1999; 7: 216–221.
59.
LeeBCMcGahanJFBijanB.Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy. J Ultrasound Med2002; 21: 731–738.
60.
GoharkhayNVermaUMaggiorottoF. Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses. Ultrasound Obstet Gynecol2007; 29: 65–69.
61.
SilvaFCastroJGodnhoC, et al. Minimally invasive approach of tubo-ovarian abscesses. Rev Bras Ginecol Obstet2015; 37(3): 115–118.
62.
DeWittJReiningAAllsworthJE, et al. Tuboovarian abscesses: is size associated with duration of hospitalization & complications?Obstet Gynecol Int2010; 2010: 847041.
63.
RivlinME.Clinical outcome following vaginal drainage of pelvic abscess. Obstet Gynecol1983; 61: 169–173.
64.
KaplanALJacobsWMEhresmanJB.Aggressive management of pelvic abscess. Am J Obstet Gynecol1967; 98: 482–487.
65.
Henry-SuchetJSolerALoffredoV.Laparoscopic treatment of tubo-ovarian abscess. J Reprod Med1984; 29: 579–582.
66.
ChuLMaHLiangJ, et al. Effectiveness and adverse events of early laparoscopic therapy versus conservative treatment for tubo-ovarian or pelvic abscess: a single-center retrospective cohort study. Gynecol Obstet Invest2019; 84(4): 334–342.
67.
RosenMBreitkopfDWaudK.Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv2009; 64: 681–689.
68.
van der VoortMHeijnsdijkEAGoumaDJ. Bowel injury as a complication of laparoscopy. Br J Surg2004; 91: 1253–1258.
69.
OrideAKanasakiHMiyazakiK.Therapeutic process of gynecological pelvic abscess – retrospective review of 20 cases. Surg Sci2013; 4: 202–209.
70.
RaigaJCanisMLe Boue··decG, et al. Laparoscopic management of adnexal abscesses: consequences for fertility. Fertil Steril1996; 66: 712–717.
71.
BuchweitzOMalikEKressinP, et al. Laparoscopic management of tubo-ovarian abscesses: retrospective analysis of 60 cases. Surg Endosc2000; 14: 948–950.
