A tubo-ovarian abscess (TOA) is an infectious mass found in the fallopian tube, ovary or near those structures. It can be due to several factors that introduce an infection but it usually develops as a complication of a condition called pelvic inflammatory disease (PID). PID is an infection of the pelvic reproductive organs that results mainly from untreated sexually transmitted infections.
Bacteria can travel up the vagina into the uterus reaching the tubes and ovaries to form a walled-off cyst known as a tubo-ovarian abscess. TOAs occur in around 15% of patients with PID and are usually polymicrobial, meaning several types of bacteria are isolated from the abscess.
A TOA can be life-threatening should it rupture and cause sepsis, a widespread infection in the patient’s bloodstream.
Risk factors for developing a TOA include:
- Young age
- Multiple sexual partners
- Sexually transmitted infections
- Uterine instrumentation, such as insertion of an IUD with an active infection, or a dilation and curettage (D&C)
- Hysteroscopy
Symptoms
- Lower abdominal pain
- Fever and/or chills
- Vaginal discharge
- Painful intercourse
- Nausea & vomiting
Evaluation & diagnosis
On suspicion of a tubo-ovarian abscess, your doctor will perform a transvaginal ultrasound and may be able to identify the mass. Further imaging, usually a CT scan, might be needed to better visualize the abscess.
Although not commonly used, laparoscopy is still considered the definitive diagnostic tool and it may allow for drainage and culture of the abscess as well.
Treatment
The most important first step in management of a TOA is starting antibiotics to avoid a widespread infection. Imaging-guided drainage by a radiologist could be attempted during antibiotic treatment.
While on this regimen, patients should be monitored for worsening symptoms or lack of improvement, which would then require surgical intervention to remove the abscess along with the affected tube or ovary.
Complications
- Recurrent PIDs
- Chronic pelvic pain
- Ectopic pregnancy, outside of the uterus
- Infertility
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. TOA surgery is technically challenging and requires a high level of surgical expertise.
Choose your surgeon with the training and the experience to manage these technically challenging conditions in a minimally invasive fashion.
Dr. Moawad is a highly reputable leading expert in this domain.
