Tubo-Ovarian Abscess - an Overview

Introduction

A tubo-ovarian abscess is an inflammatory or infectious mass in the uterus, fallopian tubes, ovaries, and ligaments that comprise the female reproductive system. The condition is mainly a PID or pelvic inflammatory disease complication when left untreated. The abscess is classified by doctors as solid, complex, or cystic, depending on its composition. TOA is a very serious complication that can be life-threatening for a person. Therefore, it requires immediate medical attention with early diagnosis. A tubo-ovarian abscess is more common in sexually active females, out of which 60 percent have never conceived. Thus, timely medical management is important to preserve fertility and prevent fatal complications caused by TOA.

What Are the Causes of Tubo-ovarian Abscess?

A tubo-ovarian abscess may develop due to the following reasons:

Pelvic Inflammatory Disease (PID)- The pathogens causing pelvic inflammatory disease are present in the vagina or cervix. These pathogens can travel to the endometrium, reach the peritoneal cavity via the fallopian tube, and form a mass or abscess. In addition, multiple pathogens, such as fungi and bacteria, may cause the condition. These pathogens include:

• Streptococci (aerobic).

• Chlamydia trachomatis.

• Escherichia coli.

• Neisseria gonorrhea.

• Peptostreptococcus anaerobius.

• Bacteroides fragilis.

A tubo-ovarian abscess (TOA) can also occur due to sexually and nonsexually transmitted infections.

Xanthogranulomatous Inflammation- There is no specific information on how xanthogranulomatous inflammation causes TOA. However, it is assumed that inflammatory responses from failed antibiotic therapy, endometriosis, or infections may cause this condition. In addition, xanthogranulomatous inflammation can form mass-like lesions and invade the surrounding tissues if they are formed in the female reproductive organs.

Infected Adjacent Organs- TOA may also spread from the infected adjacent organs, such as the appendix. In addition, the infection may also spread from various other body organs through blood.

What Are the Symptoms of Tubo-ovarian Abscess?

A person with a tubo-ovarian abscess can feel a mass in the pelvis or lower abdomen. The person also presents the symptoms of an infection, which include

• Nausea.

• Chills.

• Fever.

• Heavy and unusual vaginal discharge.

• Tenderness and pain in the lower abdomen.

• Vaginal bleeding.

In addition, a person diagnosed with tubo-ovarian abscess also presents the following symptoms:

• Cervical tenderness and excitation during examination by the doctor

• Elevated white blood cell levels.

• Pus-filled ovaries.

What Are the Risk Factors for Tubo-ovarian Abscess?

The factors that can increase the risk of developing a tubo-ovarian abscess in a person are

• Intrauterine Devices (IUD)- Immunocompromised patients with prolonged use of intrauterine devices can develop a tubo-ovarian abscess or TOA, according to a research in 2017.

• Multiple Sex Partners- Sexually transmitted diseases spread due to multiple sex partners can also make a person more prone to a tubo-ovarian abscess or TOA.

• Pelvic Inflammatory Disease (PID)- People who suffer from pelvic inflammatory diseases usually develop TOA as a complication if left untreated. Researches show that almost 20 percent of people suffering from PID develop a tubo-ovarian abscess.

• Age- Tubo-ovarian abscess is more commonly found in females aged 15 to 25. However, the condition is found with higher inflammatory markers and large abscesses in older females.

• Endometriosis- A person is more likely to develop TOA with co-existing endometriosis due to bacterial invasion.

How Is a Tubo-ovarian Abscess Diagnosed?

Diagnosis of tubo-ovarian abscesses is very challenging for doctors to diagnose. The healthcare provider analyzes the case by taking the patient's medical history and performing a pelvic examination to measure the uterus's consistency, mobility, and size. The doctor also advises following tests for better diagnosis.

• Blood Test- Blood tests show elevated TOA clinical biomarkers, including C-reactive protein, erythrocyte sedimentation rates, and white blood cell count. Blood tests also help to identify the pathogen causing the condition.

• Transvaginal Ultrasounds- The test helps to view the clear picture of female pelvic organs and anatomical structures, such as ovaries, uterus, pelvis, tubes, and cervix.

• Urine Test- The test helps the doctor discover the underlying condition, such as urinary tract infection, that may cause the condition or TOA.

• Endometrial Biopsy- In this procedure, a small piece of tissue is extracted from the uterus and examined under the microscope.

• Laparoscopy- The internal structures of the pelvis are viewed with the help of this minimally invasive process.

How Is a Tubo-ovarian Abscess Treated?

A tubo-ovarian abscess is treated in the following ways:

1. Antibiotic Medication

The first-line treatment for a tubo-ovarian abscess is broad-spectrum antibiotics. These include:

• Intramuscular (i mg) Ceftriaxone plus 100 mg Doxycycline (oral) twice daily.

• Clindamycin 900 mg intravenously (IV) every 8 hours, along with Gentamycin (IV) 5 mg/kg.

The doctors administer the medications and fluids to the patient for the initial 24 hours following the tubo-ovarian abscess diagnosis and monitor the antibiotic treatment's vital signs and effectiveness. The patient is then made to stay in the hospital for three to four days. Antibiotic therapy for treating TOA is effective in almost 70 % of people suffering from this condition.

2. Surgery

The doctor recommends the surgical method for treating TOA in the following cases:

• Rupture of the tubo-ovarian abscess.

• If the abscess is larger.

• Antibiotic therapy is ineffective.

The main aim of surgical intervention is to drain the abscess and prevent further damage by removing the affected part. The surgical method involves:

• Salpingectomy: The infection in the fallopian tube is treated with this method by removing it and preventing infection progression.

• Laparoscopy: The procedure is minor and helps to drain the abscess and remove any damaged tissue from the female reproductive system.

• Oophorectomy: The procedure removes the damage due to the abscess rupture.

What Are the Complications Associated With Tubo-ovarian Abscess?

• Infertility.

• Chronic pelvic pain.

• Ectopic pregnancy.

• Recurrent pelvic inflammatory disease.

• Distortion of the pelvic anatomy.

What Is the Differential Diagnosis for Tubo-ovarian Abscess?

• Ruptured ovarian cyst.

• Ectopic pregnancy.

• Diverticulitis.

• Inflammatory bowel disease.

Conclusion

The recovery from tubo-ovarian abscess condition is slow, despite percutaneous drainage and antibiotic therapy. Patients often require hospitalization for parenteral antibiotic therapy for TOA and often develop many life-threatening complications, such as ectopic pregnancy, septic shock, ruptured abscess, and death. Therefore, a person experiencing any symptoms of tubo-ovarian abscess should consult the doctor immediately for timely medical intervention. This can prevent fatal consequences and help preserve a person's fertility with drug therapy and surgical methods.