User:Mr. Ibrahem/Tubo-ovarian abscess

Tubo-ovarian abscess (TOA) is a mass of infectious material involving the fallopian tube or ovary, typically occurring as a result of pelvic inflammatory disease (PID) in females of childbearing age. It presents as pelvic pain, vaginal discharge, fever, and a pelvic lump. There may be nausea or abnormal vaginal bleeding. Complications can include rupture resulting in sepsis and peritonitis. Long-term issues may include chronic pelvic pain, infertility, or ectopic pregnancy.

The most common cause is as a complication of pelvic inflammatory disease. Other risks include IUD insertion, multiple sexual partners, previous PID, and pelvic organ cancer. It may occur as a complication of a hysterectomy and is associated with HIV/AIDS, diabetes, and endometriosis. Infection generally spreads from the vagina up through the inner lining of the uterus to the fallopian tubes and peritoneal cavity. It may involve adjacent pelvic organs. A nearby infection, such as of the appendix, may less commonly extend to form a tubo-ovarian abscess. Often many types of bacteria are involved with those commonly found including Escherichia coli, Bacteroides fragilis, Peptostreptococcus, Peptococcus, and aerobic streptococci.

There maybe yellow-green discharge seen from the cervix and it may hurt when the cervix is moved. Blood tests usually reveal an elevated white blood cell count. Other tests may include pregnancy test; culture of urine, cervical discharge, and blood; as well as a wet mount of vaginal discharge for clue cells. Medical imaging, such as ultrasound, CT scan, or MRI, will often show the abscess. Treatment is initially with antibiotics given by injection. Drainage via needle aspiration, laparoscopy or laparotomy, may be carried out if this is not effective. Generally hospitalization is required.

Tubo-ovarian abscesses are rare. In the United States they occurs in just over 2% of PID cases. Women between 15 and 40 years of age are most frequently affected. While death is uncommon with appropriate treatment, it may occur in up to 4% of people who have a rupture of their abscess. They were first drained via colpotomy in 1835.