Pathogenesis, Diagnosis, and Management of Severe Pelvic Inflammatory Disease and Tuboovarian Abscess

Abstract

Severe pelvic inflammatory disease and tuboovarian abscesses (TOAs) are common pelvic infections requiring inpatient admission. There are few large randomized trials guiding appropriate clinical management of TOA, including antibiotic selection and timing of surgical management and drainage. The pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and TOA are summarized and reviewed from the most current literature.

Complicated clinical course of acute pelvic inflammatory disease

“…The adherence of adjacent pelvic structures might serve a host defense mechanism to contain the inflammatory process within the pelvis. 1 This could be a reason that some women with TOA have a vague course of the disease. Tubo-ovarian mass should be strongly considered as differential diagnosis in any IUD user who presents with complaints of abdominal pain, fever or adnexal mass.…”

“…The authors also report that E. coli is the most common organism causing TOA among IUD users. 5 TOAs, unlike other types of abscesses, tend to occur between organs rather than are confined inside an organ, therefore are more likely to spread locally 1 . The adherence of adjacent pelvic structures might serve a host defense mechanism to contain the inflammatory process within the pelvis.…”

“…Studies are showing, that E. coli is common in women with ruptured TOAs and a frequent cause of gram-negative sepsis. 1,3 The second, use of an IUD has been linked to an increased risk of PID, but current IUDs may pose a substantially lower risk -less than 1%. 4 Some authors are saying that the use of an IUD for more than five years increases the risk of TOA.…”

“…The exact incidence of PID in perimenopausal women is unknown; however, less than 2% of women with TOA formation are perimenopausal. 1 Despite the rarity with which PID occurs in perimenopausal woman, consideration and early recognition of the diagnosis can be crucial.…”

Different Management Options for Tubo-Ovarian Abscess: A Tertiary Referral Center Experience

“…PID is caused by an ascending infection of lower genital tract organisms from the vagina or cervix into the uterus, fallopian tubes and peritoneal cavity (1) . TOA is characterized by an inflammatory mass involving the fallopian tube, ovary and occasionally other adjacent pelvic organs (eg.…”