Tubo Ovarian Abscesses

 

Tubo-ovarian abscesses

 

Defnition •

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an encapsulated or confned ‘pocket o pus’ with defned boundaries that orms during an inection o a allopian tube and ovary ov ary.. one o the late complications o pelvic inammatory disease (!D" lie#threatening （ ruptures ー＞ sepsis ）

 

$pidemiology •

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%he epidemiology o %&' is closely related to that o pelvic inammatory disease which is estimated to one million people yearly. %he mortality rate associated with tuboovarian abscess was approimately )* percent or higher prior to the advent o broad# spectrum antibiotics and modern surgical practice . !n current practice+ the -urrent mortalitymortality rate approaches or abscesses that have not ruptured. rates or,ero patients with ruptured abscesses are not reported in the literature data rom the /01*s suggested a mortality rate ranging rom /.2 to 3.2 percent .

 

athophysiology •

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 're presumed to occur in 4 stages %he frst stage is ac5uisition o a vaginal or cervical inection. %his inection is oten seually transmitted and may be asymptomatic. %he secondor stage is direct o microorganisms the vagina cervi to the ascent upper genital tract+ with rom inection and inammation o these structures.

 

athophysiology  （２） •

%he vaginal ora o most normal+ healthy women includes a variety o potentially pathogenic bacteria . 'mong these are species o streptococci+ staphylococci+ $nterobacteriaceae (most commonly Klebsiella spp+ Escherichia coli coli+ and Proteus spp"+ and a variety o anaerobes. -ompared with the dominant+ non#pathogenic+ hydrogen peroide# producing Lactobac  Lactobacillus illus species+ these other organisms are present in low numbers+ and ebb and ow under the inuence o hormonal changes (eg+ pregnancy pregnancy++ menstrual cycle"+ contraceptive method+ seual activity+ activity+ and other as

 

athophysiology  （３） •

%he endocervical canal unctions as a barrier protecting the normally sterile upper genital tract rom the organisms o the dynamic vaginal ecosystem. $ndocervical inection with seually transmitted pathogens can disrupt this barrier. Disturbance o this barrier provides vaginal bacteria access to the upper genital organs+ inecting the endometrium+ then endosalpin+ ovarian corte+ pelvic peritoneum+ and their underlying stroma. %he resulting inection may be subclinical or maniest as the clinical entity o pelvic inammatory disease (!D". %he reasons why lower genital tract bacteria cause !D in some women but not others is not ully understood but may relate to genetic variations in immune response+ estrogen levels a6ecting the viscosity o cervical mucus+ and bacterial load

 

Diagnosis •

7aparoscopy and other imaging tools can visuali,e the abscess. hysicians are able to make the diagnosis i the abscess ruptures when the woman begins to have lower abdominal pain that then begins to spread. %he symptoms then become the same as the symptoms or peritonitis. 8epsis+ occurs i let untreated. 9ltrasonography is a sensitive enough imaging tool that it can accurately di6erentiate between pregnancy+ hemorrhagic ovarian cysts+ endometriosis+ ovarian torsion+ pregnancy+ and tubo#ovarian abscess. !ts availability+ availability+ the relative advancement in the training o its use+ its low cost+ and because it does not epose the woman (or etus" to ioni,ing radiation+ ultrasonography an ideal imaging procedure or women o reproductive age.

 

%reatment •

%reatment or %&' di6ers rom !D in that some clinicians recommend patients with tubo#ovarian abscesses have at least 4: hours o inpatient parenteral treatment with antibiotics+ and that they may re5uire surgery. surgery. ! surgery becomes necessary++ pre#operative administration o broad#spectrum antibiotics is started and necessary removal o the abscess+ the a6ected ovary and allopian tube is done. 'ter discharge rom the hospital+ oral antibiotics are continued or the length o time prescribed by the physician.

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%reatment is di6erent i the %&' is discovered beore it ruptures and can be treated with !; antibiotics. During this treatment+ !; antibiotics are usually replaced with oral antibiotics on an outpatient basis. atients are usually seen three days ater hospital discharge and then again one to two weeks later to confrm that the inection has cleared.