Tubo-ovarian abscess: A retrospective review

Ginsburg, David; Stern, Jeffrey L.; Hamod, Kamal A.; Genadry, Rene R.; Spence, Michael R.

doi:10.1016/0002-9378(80)91107-2

Cited by 86 publications

(48 citation statements)

References 4 publications

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“…Although investigators have commented that abscess size may influence outcome [145,146], only in cases of tubo-ovarian abscess has abscess size been demonstrated to influence outcome [147].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Bamberger

1996

Clinical Infectious Diseases

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The usual treatment of bacterial abscesses, except lung or tubo-ovarian abscesses, includes therapeutic drainage. Increasing evidence suggests that some abscesses respond to antimicrobial therapy without drainage. To study this issue, a MEDLINE search of the literature was performed for cases of bacterial abscess in which treatment without definitive drainage was attempted. Four hundred sixty-five cases were identified. The most commonly involved organs were the liver, brain, and kidney. The success rate of antimicrobial therapy was 85.9%. Factors that predicted a less favorable outcome were abscess diameter of~5 em (odds ratio [OR] = 37.7; P = .0003), involvement of~1 organism (OR = 5.2; P = .014), presence of gram-negative bacilli (OR = 3.4; P = .022), length of therapy of <4 weeks (OR = 49.1; P < .0001), and use of an aminoglycoside as the only active agent (OR = 11.8; P = .008). Many bacterial abscesses can be treated without drainage; abscess size, the organisms involved, and therapy utilized may influence outcome.Bacterial abscesses usually require drainage for cure. Reasons postulated for the ineffectiveness of antibiotics in the treatment of abscesses include the presence of stationary-phase organisms, low pH, high protein content, the large number of bacteria within abscesses, ionic composition, low oxygen tension, sequestration of bacteria within leukocytes, low abscess zinc concentrations, and the presence of antimicrobial agent-deactivating enzymes [1]. Antimicrobial therapy is generally ineffective in experimental models of suppurative infections when initiation of therapy is delayed for ;?:24 hours [2].See the editorial response by Lerner on pages 604-7.It has long been recognized that lung abscesses respond to prolonged courses of antimicrobials without formal surgical drainage. Since many lung abscesses have air-fluid levels that were observed radiographically, suggesting bronchial communication, it is likely that lung abscesses spontaneously drain via the bronchial tree. It has also been well recognized that most abscesses of the tubo-ovarian region-especially those <8 em in diameter-respond to antimicrobial therapy without the need for surgical drainage [3], perhaps again because spontaneous drainage occurs via the fallopian tubes. Since the 1970s there has been an increasing number of reports of other abscesses, especially those involving the brain, liver, and kidney, that have responded to antimicrobial therapy without the need for a drainage procedure. This report reviews the literature regarding medical treatment ofbacterial abscesses in order to determine the extent of the clinical experience documented to date and to define the clinical, microbiological, and therapeutic features of abscesses responding to medical therapy. Since routine initial therapy for lung and tubo-ovarian abscesses no longer includes a drainage procedure, these cases were excluded. MethodsA MEDLINE search of the literature from 1966 to August 1994 was done to find all English-language reports of bacterial abscesses ...

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Section: Discussionmentioning

confidence: 99%

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Bamberger

1996

Clinical Infectious Diseases

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“…The predisposing factors in the development of TOA include nulliparity (in 25-50% of cases), previous episodes of PID, multiple sexual partners and the use of intrauterine device (IUD) [3][4][5][6][7]. A number of studies have shown that a prior history of PID is obtained in only one third to one half of patients presenting with TOA [1,[4][5][6]. Nevertheless, the development of TOA has been referred to as an end stage in the progression of upper genital tract infections [4,8].…”

Section: Introductionmentioning

confidence: 99%

Tubo-Ovarian Abscess in Older Women: Is the Woman’s Age a Risk Factor for Failed Response to Conservative Treatment?

Halperin

Levinson

Yaron

et al. 2003

Gynecol Obstet Invest

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Objective: To assess retrospectively if there is a trend of change in the epidemiology of tubo-ovarian abscess (TOA) and to define the epidemiologic, clinical and laboratory risk factors associated with failed response to conservative antibiotic therapy. Study Design: The charts of 60 patients, admitted with clinically and sonographically diagnosed TOA between January 1995 and December 2000, were reviewed. On admission, all patients were treated with broad-spectrum antibiotics, and were divided into two groups according to the response to medical treatment. Forty-three patients, responding to antibiotic therapy, constituted group A, whereas 17 patients who did not respond and were further treated by sonographically guided drainage or surgery, were included in group B. The groups were compared with respect to patient characteristics, clinical and sonographic presentation, laboratory findings, duration of hospital stay and recovery rate of different pathogens from the endocervix. Results: The mean age of patients responding to medical therapy (group A) was significantly lower (39.6 ± 8.3) than the age of patients who did not respond (group B) (45.3 ± 6.6) (p = 0.02). The gravidity as well as the percentage of menopausal women were significantly increased in group B (p = 0.03 and p = 0.02, respectively). There was a significantly lower incidence of previous pelvic surgery and past history of PID in group B versus group A (p = 0.02 and p = 0.03, respectively), yet the duration of IUD use was significantly prolonged in group B (p = 0.02). The size of TOA, evaluated clinically and sonographically, was significantly increased in group B compared with group A (p = 0.04 and p = 0.009, respectively). Pelvic peritonitis was observed in 40% of group B patients and in none of group A patients (p = 0.0001). The only laboratory finding differentiating between the two groups was the mean sedimentation rate, being significantly higher in group B than in group A (p = 0.0005). The time interval from admission to afebrile condition as well as the duration of hospitalization were significantly shorter in group A (6.1 ± 2.3 days) than in group B (10.7 ± 4.7 days) (p = 0.00003). The incidence of positive culture from the endocervix was significantly higher in group B than in group A (p = 0.007). One hundred percent of patients in group B versus 65.2% of patients in group A were treated with triple agent therapy (p = 0.007). Conclusion: The results of the current study strengthen our previous assumption that there is probably a new trend in the epidemiology of TOA, occurring in older women, who do not present the traditional risk factors for pelvic inflammatory disease and TOA.

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“…9 In our series, we found abdominal pain as the most common presenting symptom. Ginsburg et al 10 reported previous PID in TOA patients as %49. Our patients had a 21.1% previous PID rate.…”

Section: Discussionmentioning

confidence: 98%

Surgical management of tuboovarian abscess: Results of retrospective case series

Cengiz

Dağdeviren²,

Ekin³

et al. 2012

J Clin Exp Invest

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ÖZETAmaç: Tubaovaryan apse (TOA) ciddi ve hayati tehlikesi bulunan bir durumdur. Tedavi şekilleri olarak geniş spektrumlu antibioterapi, minimal invaziv abse drenajı, invaziv cerrahi veya bu tedavi usullerinin kombinasyonunu içer-mektedir. Bu çalışmanın amacı cerrahi olarak tedavi edilmiş TOA olgularını değerlendirmektir. Bulgular: TOA olgularında ortalama yaş 37.2 olarak saptandı. Ortalama gravida ve parite sırası ile 2.9 ve 2.1 olarak bulundu. En sık saptanan semptom olarak %47.4 (n=27) oranı ile karın ağrısı izlendi. %49.1(n=28) hasta laparatomik cerrahi ve %50.9 (n=29) hasta laparaskopik cerrahi geçirdi. 6 hastada rüptüre TOA izlendi ve %17.9 hastada komplikasyon gelişti. Gereç ve yöntem:Sonuç: Gerekli cerrahi müdahaleleri gerçekleştirmek için, açık veya laparoskopik cerrahi yaklaşımın seçimi büyük ölçüde operatörün beceri, deneyim ve yeteneğine bağlıdır.Anahtar kelimeler: Cerrahi, Komplikasyon, laparoskopi, tubaovaryan apse ABSTRACT Objectives: Tuboovarian abscess (TOA) is a serious and potentially life-threatening condition. Treatment modalities vary as broad spectrum of antibiotherapy, minimallyinvasive drainage procedures, invasive surgery or combinations of these interventions. The objective of this study was to evaluate surgically treated patients for TOA. Materials and methods:The medical records of 57 cases who had surgically treated for TOA at Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Obstetrics and Gynecology from January 2007 to September 2012 were evaluated retrospectively. Results:The average age was 37.2 years and the mean gravidity and parity were 2.9 and 2.1, respectively. The most common presenting symptom was abdominal pain 47.4% (n=27). Twenty eight (49.1%) of the patients had laparotomy and twenty nine (50.9%) of the patients had laparoscopic surgery. 6 patients had a ruptured TOA and 17.9% of the patients had complications. Conclusions:The choice of an open or laparoscopic surgical approach should be largely based on operator skill, experience, and ability to perform the necessary surgical maneuvers.

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Tubo-ovarian abscess: A retrospective review

Cited by 86 publications

References 4 publications

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Tubo-Ovarian Abscess in Older Women: Is the Woman’s Age a Risk Factor for Failed Response to Conservative Treatment?

Surgical management of tuboovarian abscess: Results of retrospective case series

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