Tubo-ovarian abscesses

Pelvic inflammatory disease if left untreated leads to tubo-ovarian abscess.  There is a risk to life if the abscess ruptures and becomes septic.  Tubo-ovarian abscesses are pockets of pus which have fixed boundaries that develop due infection of the fallopian tube and ovary. Women of reproductive age are more prone to these abscesses which are a result of upper genital tract infection.  Any complications during a hysterectomy procedure can lead to tubo-ovarian abscess.

What are the symptoms?

Symptoms of tubo-ovarian abscess are fever, high white blood cells, lower abdominal and pelvic pain, vaginal discharge. TOAs are often caused by multiple micro-organisms.

Symptoms of tubo-ovarian abscess (TOA) and pelvic inflammatory disease are similar except that the abscess can be diagnosed with an MRI, x-ray, or sonography. The other exception is that it is accompanied by symptoms of acute-onset pelvic pain.

What are the causes?

Tubo-ovarian abscess is a complication that occurs in the last stage of PID.   Tubo-ovarian abscess is an inflammatory tumor which engulfs the fallopian tube, ovary and sometimes nearby pelvic organs.  The other cause is that it may be due to spread of infection during pelvic or abdominal surgery or sometimes a necrotic ovarian malignancy.

What tests will be required for diagnosis?

Your doctor will first note down your symptoms and examine you. In examination your doctor will feel your tummy first to see for any tenderness (pain on touch) and then do internal examination at this point of time, they may take a swab from the vagina for test to see what type of infection you have.

You may be advice to undergo further test, to help in the diagnosis such as

  1. Blood test
  2. Urine test
  3. Ultrasound (USG)
  4. Endometrial biopsy to take a sample of cells from the inside of your uterus and check them for infection
  5. Sometime you may require diagnostic laparoscopy (put telescope into your tummy, this is surgery) for accurate diagnosis of tubo-ovarian abscess.
What are the treatment options available?

Treatment for TOA is not the same as PID.  If TOA is detected before it ruptures, IV antibiotics are given as treatment.  In some cases 24-hour hospital admission is required to treat TOAs when patients are given antibiotics through a tube.  Surgery is the only option if the abscess ruptures.  During surgery, the abscess as well as the affected fallopian tube and ovary are removed.  It is advisable to complete the full course of antibiotics prescribe by the physician after surgery.