Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review

Goje, Oluwatosin; Markwei, Metabel; Kollikonda, Swapna; Chavan, Monica; Soper, David E.

doi:10.1016/j.jmig.2020.09.014

Cited by 26 publications

(27 citation statements)

References 22 publications

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“…Abscess size is consistently identi ed as a factor associated with medical management failure. However, thresholds for this association differ across studies, ranging from TOA size of 4.5 to 8 cm [12,13]. In our study population, medical management failure was independently associated with the abscess size, with the smallest TOA failing medical management measuring 5.6 cm.…”

Section: Discussionmentioning

confidence: 67%

“…In our study population, medical management failure was independently associated with the abscess size, with the smallest TOA failing medical management measuring 5.6 cm. Image-guided drainage of TOAs is more effective and associated with fewer complications as compared to operative management of complicated TOAs [13]. If performed for TOAs greater than 5.5 cm in diameter, early drainage could avert primary medical management failure and decrease the length of hospital stays.…”

Section: Discussionmentioning

confidence: 99%

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Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Lee

Novatt

Sripras

et al. 2022

Preprint

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Purpose: To identify patient factors associated with medical management failure and hospital readmission among patients admitted with a diagnosis of tuboovarian abscess at a public hospital in Los Angeles, California. Methods: We conducted a retrospective chart review of admissions for tuboovarian abscess from January 2014 through August 2019, describing treatment plans and their subsequent outcomes. Patient factors associated with failure of medical management, as defined by requiring image-guided drainage or surgery, and hospital readmission were identified via bivariate analyses, using Chi-square, Fisher’s exact, and Wilcoxon signed-rank tests as appropriate. Factors independently linked to failure of medical management were determined via logistic regression. Results: We treated 147 patients with tuboovarian abscess over 5 years, comprised primarily of Hispanic/Latinx (74%; n=109/147) women, median age 39 (range: 18-70) years. The median abscess size was 6.3cm (range: 4.8-8.0). Only 16% (n=23/147) who initially received parenteral antibiotic therapy failed medical management. Factors independently and positively linked to parenteral antibiotic failure included elevated white blood cell count (aOR 1.17; 95%CI 1.04-1.32) and abscess size (aOR 1.07; 95%CI 1.04-1.10). No tuboovarian abscesses under 5.5 centimeters required procedural intervention when treated with parenteral antibiotics alone. We identified rehospitalizations among 13.6% (n=20/147) of patients; no factors were significantly linked to rehospitalization.Conclusions: Tuboovarian abscesses were successfully treated with medical management in more than 80% of cases. Early procedural intervention for tuboovarian abscesses greater than 5.5 centimeters in diameter may help to avoid short and long-term morbidities.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Lee

Novatt

Sripras

et al. 2022

Preprint

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“…The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%) [10]. A systematic review indicates that better outcomes in the management of TOA were achieved via a minimally invasive approach compared to conservative treatment with antibiotics only [11]. But how to predict the necessity for invasive intervention in TOA?…”

Section: Discussionmentioning

confidence: 99%

“…Levin et al [13] found that CA-125 level was the only independent factor associated with failure of conservative parenteral antibiotic therapy for TOA (OR; 95% con dence interval [CI], 1.27,1.08-1.48, p = 0.03). Moreover, abscesses larger than 10 clinepagem have greater than 60% chance of surgery in addition to antibiotics [11]. The size of TOA may be another predictor for the need of invasive intervention.…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction Caused by Tubo-Ovarian Abscess Following Chronic Pelvic Inflammatory Disease: A Case Report

Zhang

Zhao

et al. 2021

Preprint

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BackgroundAlthough there are reports of small bowel obstruction (SBO) secondary to tubo-ovarian abscess (TOA), there have been no documented cases of unexpected SBO, multiple intestinal ruptures and adhesions in a patient with chronic PID followed by successful surgical treatment of TOA who was successfully treated by surgery after failure by conservative treatment.Case presentationA 40-year-old female was admitted with main complaint of abdominal pain and fever for six days. A pelvic mass measuring 6.37x7.85x9.04 cm and ascites at rectovaginal pouch were found despite local treatment with metronidazole and cefazolin. Laboratory tests revealed leukocytosis of 8.9x10^9/L with hyper-neutrocytophilia of 82.8%, C-reactive protein increase at 223 mg/L and Procalcitonin 0.14ng/L. The patient was diagnosed with an acute attack of chronic PID. Tests and body temperature improved after 4 days of IV antibiotics. However, two days later, the patient presented abdominal distension, poor appetite, and difficulty in defecation. Abdominal CT suggested possibility of bowel obstruction. Accordingly, an explorative laparoscopy was performed, revealing 500ml pale yellow ascites within the abdominal cavity. The intestinal tube was clearly dilated with poor peristalsis. Multiple intestinal ruptures and adhesions were found. Dense adhesion existed between the intestinal loop and posterior uterus wall, closing the rectouterine pouch. Pale yellow thick pus could be seen from the end of fallopian tube, and part of the right ovary showed serious pyosis. All the adhesions were split, ruptures were repaired and normal anatomy was restored. Postoperative pathology indicated acute and chronic inflammation of both fallopian tubes with focal abscess formation. The patient was discharged 15 days after operation and followed up at one month without any symptoms.ConclusionIn such cases, close attention should be paid to changes in the patient’s condition and lesion changes. Early laparoscopy is advised when there are significant clinical or CT scan signs of bowel obstruction in TOA patients. Precise predictors or a predictive model for the need of invasive intervention to TOA will require further investigation.

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“…In fact, a systematic review comparing the success rates of 3 modalities of minimally invasive management of tubo-ovarian abscesses-laparoscopy, ultrasound-guided drainage and computed tomographyguided drainage-reported that better outcomes were achieved by the minimally invasive approach when compared with conservative management. Of these techniques, image-guided drainage provided the highest success rates, fewest complications, and shortest hospital stay compared to laparoscopy [33].…”

Section: Treatmentmentioning

confidence: 99%

Surgical Site Infection after Hysterectomy

Chan¹,

Nimaroff²

2022

Hysterectomy - Past, Present and Future

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Surgical site infections (SSIs) are associated with increased morbidity, mortality, and healthcare costs. SSIs are defined as an infection that occurs after surgery in the part of the body where the surgery took place. Approximately 1–4% of hysterectomies are complicated by SSIs, with higher rates reported for abdominal hysterectomy. Over the past decade, there has been an increasing number of minimally invasive hysterectomies, in conjunction with a decrease in abdominal hysterectomies. The reasons behind this trend are multifactorial but are mainly rooted in the well-documented advantages of minimally invasive surgery. Multiple studies have demonstrated a marked decrease in morbidity and mortality with minimally invasive surgeries. Specifically, evidence supports lower rates of SSIs after laparoscopic hysterectomy when compared to abdominal hysterectomy. In fact, the American College of Obstetricians and Gynecologist recommends minimally invasive approaches to hysterectomy whenever feasible. This chapter will review the current literature on surgical site infection (SSI) after hysterectomy for benign indications.

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Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review

Cited by 26 publications

References 22 publications

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Small Bowel Obstruction Caused by Tubo-Ovarian Abscess Following Chronic Pelvic Inflammatory Disease: A Case Report

Surgical Site Infection after Hysterectomy

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