Management and complications of tubo-ovarian abscesses: a brief literature review

Year 2024, Volume: 10 Issue: 5, 533 - 543, 04.09.2024

Güzide Ece Akıncı , Teymur Bornaun , Hamit Zafer Güven

https://doi.org/10.18621/eurj.1467569

Abstract

Tubo-ovarian abscesses (TOAs) are identified as a severe and complex form of inflammatory disorder, marking an advanced progression of pelvic inflammatory disease (PID), mainly resulting from the escalation of polymicrobial infections within the female genital tract. This literature review is dedicated to elucidating the contemporary management strategies and associated complications of TOAs, amalgamating the current scholarly discourse while spotlighting the emerging therapeutic trends. The inherent complexity of TOAs, manifesting through a broad array of clinical presentations from mild symptoms to acute pelvic discomfort and fever, necessitates a comprehensive, multidisciplinary approach to achieve effective management. Traditional management has predominantly focused on antibiotic therapy, the cornerstone of initial treatment modalities. Nonetheless, this review expands on the increasing acknowledgment of minimally invasive surgical interventions, like ultrasound-guided drainage, especially in scenarios where medical therapy falters or in the presence of sizable abscesses, underscoring scenarios where antibiotic treatment may be insufficient. The discourse further explores the pivotal decision-making concerning surgical interventions, juxtaposing the benefits of abscess resolution against potential risks and complications, such as damage to adjacent structures and implications for future fertility. The review emphasizes the criticality of addressing PID’s risk factors and root causes to avert TOA development. It also ventures into the ramifications of the emergence of antibiotic-resistant bacterial strains for empirical antibiotic therapy selection, highlighting the imperative for continuous research and the adaptation of therapeutic guidelines. The complications associated with TOAs, including sepsis, infertility, and chronic pelvic pain, are meticulously examined to underscore the potential for significant long-term morbidity. Advocating for prompt diagnosis and encompassing management strategies to curtail these adverse outcomes, the review ultimately calls for intensified, quality research to refine TOA management further, particularly against the backdrop of evolving microbial resistance and the advancements in minimally invasive surgical technologies.

Keywords

Tubo-ovarian abscess, pelvic inflammatory disease, minimally invasive surgical intervention, infertility

References

• 1. Matsubara S, Mabuchi S, Takeda Y, Kawahara N, Kobayashi H. Prognostic value of pre-treatment systemic immune-inflammation index in patients with endometrial cancer. PLoS One. 2021;16(5):e0247635. doi: 10.1371/journal.pone.0248871.
• 2. Nie D, Gong H, Mao X, Li Z. Systemic immune-inflammation index predicts prognosis in patients with epithelial ovarian cancer: A retrospective study. Gynecol Oncol. 2019;152(2):259-564. doi: 10.1016/j.ygyno.2018.11.034.
• 3. Jing X, Li C, Sun J, et al. Systemic Inflammatory Response Markers Associated with Infertility and Endometrioma or Uterine Leiomyoma in Endometriosis. Ther Clin Risk Manag. 2020;16:403-412. doi: 10.2147/TCRM.S232849.
• 4. Reed SD, Landers DV, Sweet RL. Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. Am J Obstet Gynecol. 1991;164(6 Pt 1):1556-61; discussion 1561-2. doi: 10.1016/0002-9378(91)91436-z.
• 5. Fouks Y, Cohen A, Levin I, Grisaru D, Almog B, Lessing JB. Surgical intervention in patients with tubo-ovarian abscess: clinical predictors and a simple risk score. J Minim Invasive Gynecol. 2019;26(3):535-543. doi: 10.1016/j.jmig.2018.06.013.
• 6. Erenel H, Aydogan Mathyk B, Sal V, Ayhan I, Karatas S, Koc B. Usefulness of serum procalcitonin levels in predicting tubo-ovarian abscess in patients with acute pelvic inflammatory disease. Gynecol Obstet Invest. 2017;82(3):262-266. doi: 10.1159/000449161.
• 7. Lee SW, Kim YJ, Chung HH, Song YS, Seo JS. Predictive markers of tubo-ovarian abscess in pelvic inflammatory disease. Gynecol Obstet Invest. 2016;81(1):97-104. doi: 10.1159/000381772.
• 8. Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severity of acute pelvic inflammatory disease. Am J Obstet Gynecol. 1993;169(4):1143-1149. doi: 10.1016/0002-9378(93)90271-J.
• 9. Jennings LK, Krywko DM. Pelvic Inflammatory Disease. 2023 Mar 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
• 10. Kreisel K, Torrone E, Bernstein K, Hong J, Gorwitz R. Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age - United States, 2013-2014. MMWR Morb Mortal Wkly Rep. 2017;66(3):80-83. doi: 10.15585/mmwr.mm6603a3.
• 11. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi: 10.15585/mmwr.rr7004a1.
• 12. Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol. 1993;36(2):433-444. doi: 10.1097/00003081-199306000-00028.
• 13. Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039-2048. doi: 10.1056/NEJMra1411426.
• 14. Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet. 2000;356(9234):1013-1019. doi: 10.1016/S0140-6736(00)02699-4.
• 15. Lee YC, Min D, Holcomb K, Buhl A, DiMaio TM, Abulafia O. Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis. Gynecol Oncol. 2000;79(3):318-323. doi: 10.1006/gyno.2000.5994.
• 16. Hillier SL, Bernstein KT, Aral S. A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. J Infect Dis. 2021;224(12 Suppl 2):S23-S28. doi: 10.1093/infdis/jiab116.
• 17. Jackson SL, Soper DE. Pelvic inflammatory disease in the postmenopausal woman. Infect Dis Obstet Gynecol. 1999;7(5):248-52. doi: 10.1002/(SICI)1098-0997(1999)7:5<248::AID-IDOG8>3.0.CO;2-V.
• 18. Reekie J, Donovan B, Guy R, et al; Chlamydia and Reproductive Health Outcome Investigators; Chlamydia and Reproductive Health Outcome Investigators. Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study. Clin Infect Dis. 2018;66(3):437-443. doi: 10.1093/cid/cix769.
• 19. De Muylder X, Laga M, Tennstedt C, Van Dyck E, Aelbers GN, Piot P. The role of Neisseria gonorrhoeae and Chlamydia trachomatis in pelvic inflammatory disease and its sequelae in Zimbabwe. J Infect Dis. 1990;162(2):501-5. doi: 10.1093/infdis/162.2.501.
• 20. Cox SM, Shelburne P, Mason RA, Gloyd V, Rodgers M. Role of Neisseria gonorrhoeae and Chlamydia trachomatis in intraabdominal abscess formation in the rat. J Reprod Med. 1991;36(3):202-205.
• 21. Hsu CT, Roan CH, Rai SY, et al. Actinomycosis affecting the fallopian tube and ovary: report of 3 cases, with special reference to 2 cases following IUD application. Asia Oceania J Obstet Gynaecol. 1988;14(3):275-84. doi: 10.1111/j.1447-0756.1988.tb00104.x.
• 22. Tugrul Ersak D, Ersak B, Kokanalı MK. The effect of intrauterine device presence and other factors in medical treatment success of tuboovarian abscess. J Gynecol Obstet Hum Reprod. 2021;50(5):101983. doi: 10.1016/j.jogoh.2020.101983.
• 23. Protopapas AG, Diakomanolis ES, Milingos SD, et al. Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol. 2004;114(2):203-209. doi: 10.1016/j.ejogrb.2003.10.032.
• 24. Cohen CR, Sinei S, Reilly M, et al. Effect of human immunodeficiency virus type 1 infection upon acute salpingitis: a laparoscopic study. J Infect Dis. 1998;178(5):1352-1358. doi: 10.1086/314465.
• 25. Kirkcaldy RD, Harvey A, Papp JR, et al. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance - The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014. MMWR Surveill Summ. 2016;65(7):1-19. doi: 10.15585/mmwr.ss6507a1.
• 26. Groseclose SL, Buckeridge DL. Public Health Surveillance Systems: Recent Advances in Their Use and Evaluation. Annu Rev Public Health. 2017;38:57-79. doi: 10.1146/annurev-publhealth-031816-044348.
• 27. Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol. 2005;193(4):1323-13230. doi: 10.1016/j.ajog.2005.06.019.
• 28. Goharkhay N, Verma U, Maggiorotto F. Comparison of CT‐ or ultrasound‐guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo‐ovarian abscesses. Ultrasound Obstet Gynecol. 2007;29(1):65-69. doi: 10.1002/uog.3890.
• 29. Kapustian V, Holub Z, Jabor A. Is intrauterine device a risk factor for failure of conservative management in patients with tubo-ovarian abscess? An observational retrospective study. Arch Gynecol Obstet. 2018;297(5):1201-1204. doi: 10.1007/s00404-018-4690-z.
• 30. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222. doi: 10.1158/1078-0432.CCR-14-0442.
• 31. Vural T, Bayraktar B, Yıldırım Karaca S, Gurbuz E, Ozeren M, Taner CE. Can the risk factors predicting surgical treatment be determined in patients with tubo-ovarian abscess? Gynecol Obstet Reprod Med. 2022;29(1):63-71. doi: 10.21613/GORM.2022.1325.
• 32. Kim HY, Yang JI, Moon CS. Comparison of severe pelvic inflammatory disease, pyosalpinx, and tubo-ovarian abscess. J Obstet Gynaecol Res. 2015;41(5):742-746. doi: 10.1111/jog.12617.
• 33. Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):667-678. doi: 10.1016/j.bpobgyn.2009.01.010.
• 34. Gözüküçük M, Yıldız EG. Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis. Gynecol Surg. 2021;18:14. doi: 10.1186/s10397-021-01095-6.
• 35. Çoşkun B, Şimşir C. Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases: Tuboavarian Abscess Treatment. Med Sci Discov. 2019;6(10):235-240. doi: 10.36472/msd.v6i10.309.
• 36. Kose C, Korpe B, Korkmaz V, Ustun YE. The role of systemic immune inflammation index in predicting treatment success in tuboovarian abscesses. Arch Gynecol Obstet. 2023;308(4):1313-1319. doi: 10.1007/s00404-023-07107-4.
• 37. Mitchell C, Prabhu M. Pelvic inflammatory disease: Current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 2013;27(4):793-809. doi: 10.1016/j.idc.2013.08.004.
• 38. Romosan G, Valentin L. The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature. Arch Gynecol Obstet. 2014;289(4):705-714. doi: 10.1007/s00404-013-3091-6.
• 39. Spain J, Rheinboldt M. MDCT of pelvic inflammatory disease: a review of the pathophysiology, gamut of imaging findings, and treatment. Emerg Radiol. 2017;24(1):87-93. doi: 10.1007/s10140-016-1444-8.
• 40. Czeyda-Pommersheim F, Kalb B, Costello J, et al. MRI in pelvic inflammatory disease: a pictorial review. Abdom Radiol (NY). 2017;42(3):935-950. doi: 10.1007/s00261-016-1004-4.
• 41. Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018;29(2):108-114. doi: 10.1177/0956462417744099.
• 42. Park ST, Kim MJ, Ko YB, Lee EJ, Choi YS. Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. BMC Womens Health. 2017;17(1):5. doi: 10.1186/s12905-016-0356-9.
• 43. Avendaño ALEM, Totomoch Arroyo JA, Villarreal Portillo DA, Moreno MM. Diagnosis and Treatment of Fitz-Hugh-Curtis Syndrome: Review of Current Literature. Int J Med Sci Clin Res Stud. 2023;3(5):871-873. doi: /10.47191/ijmscrs/v3-i5-16.
• 44. Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Tubo-ovarian abscess. Am J Emerg Med. 2022;57:70-75. doi: 10.1016/j.ajem.2022.04.026.
• 45. McNeeley SG, Hendrix SL, Mazzoni MM, Kmak DC, Ransom SB. Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess. Am J Obstet Gynecol. 1998;178(6):1272-1278. doi: 10.1016/s0002-9378(98)70333-3.
• 46. Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis. 2004;39(7):990-995. doi: 10.1086/423963.
• 47. Dewitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalization & complications? Obstet Gynecol Int. 2010;2010:847041. doi: 10.1155/2010/847041.
• 48. Demirtas O, Akman L, Demirtas GS, Hursitoglu BS, Yilmaz H. The role of the serum inflammatory markers for predicting the tubo-ovarian abscess in acute pelvic inflammatory disease: a single-center 5-year experience. Arch Gynecol Obstet. 2013;287(3):519-523. doi: 10.1007/s00404-012-2600-3.
• 49. Ribak R, Schonman R, Sharvit M, Schreiber H, Raviv O, Klein Z. Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements. J Minim Invasive Gynecol. 2020;27(2):541-547. doi: 10.1016/j.jmig.2019.04.027. Epub 2019 Aug 31.
• 50. Sharma R. To Evaluate Role of Transvaginal Sonography over Transabdominal Sonography in Delineating Adnexal Masses. JK Science. 2019;21(1):26-34.
• 51. Jeong WK, Kim Y, Song SY. Tubo-ovarian abscess: CT and pathological correlation. Clin Imaging. 2007;31(6):414-418. doi: 10.1016/j.clinimag.2007.04.024.
• 52. Hoffman M, Molpus K, Roberts WS, Lyman GH, Cavanagh D. Tuboovarian abscess in postmenopausal women. J Reprod Med. 1990;35(5):525-528.
• 53. Inal ZO, Inal HA, Gorkem U. Experience of Tubo-Ovarian Abscess: A Retrospective Clinical Analysis of 318 Patients in a Single Tertiary Center in Middle Turkey. Surg Infect (Larchmt). 2018;19(1):54-60. doi: 10.1089/sur.2017.215.
• 54. Kanyildiz B. Patients with Pelvic Inflammatory Disease vs. Tuboovarian Abscess: Comparison of Follow-Up and Treatment Processes. Clin Med Rev Case Rep. 2022;9(2):383. doi: 10.23937/2378-3656/1410383.
• 55. Yongue G, Mollier J, Anin S, et al. Tubo-ovarian abscess: A proposed new scoring system to guide clinical management. Int J Gynaecol Obstet. 2022;157(3):588-597. doi: 10.1002/ijgo.13932.
• 56. Göksever Çelik H, Çelik E, Yüksel S, Baştu E. Different Surgical Techniques in Tubo-Ovarian Abscess Management. Gynecol Obstet Reprod Med. 2017;23(1):32-36. doi: 10.21613/GORM.2016.639.