The Clinical Management Of 59 Tubo-Ovarıan Abscess Cases

Year 2022, , 131 - 137, 30.08.2022

Feyza Bayram , Mehmet Musa Aslan

https://doi.org/10.34084/bshr.1113655

Abstract

This study aims to retrospectively evaluate the incidence, risk factors, clinical and laboratory outcomes, complications and management strategies of the tubo-ovarian abscess (TOA).
The records of 59 patients who had been hospitalised with the diagnosis of tubo-ovarian abscess between January 2016 and January 2021 were studied retrospectively. The patients’ clinical and laboratory results, operational methods applied, and the complications raised were recorded. Demographic data and sonographic findings of the patients were reported.
The mean age of the patients was 36.53 ± 9.26 years. The most common complaints were pelvic pain (100%), vaginal discharge (42.4%), fever (35.6%) and menstrual irregularity (30.5%). The mean abscess size was 6.31 ± 2.08 [3-12] cm. The patients were divided into two groups as those who underwent surgery and received only medical treatment. While only medical treatment was sufficient in 28 (47.5) patients, surgical treatment was applied to 31 (52.5%) patients. There was no statistical difference in terms of gravida, parity, BMI, duration of the marriage, PIH (pelvic inflammatory disease) history, previous operation history and additional systemic disease. The presence of an intrauterine device (IUD), duration of IUD use, and TOA size were significantly higher in the surgical group. Abscess sizes in patients who used only medical treatment were statistically significantly lower than in those who required surgery (4.22 × 1.94 cm, 8.15 × 2.28 cm; p<0.001). The hospital stay was also shorter in the medical treatment group (p: 0.629). The most common surgical complications were bladder damage (12.9%), bowel perforation (9.6%), and ureteral damage (9.6%), respectively. The pathology report of only one patient was detected as malignant (3.2%).
Early diagnosis and treatment of TOA are essential as it has severe life-threatening consequences such as morbidity and mortality. The appropriate treatment method should be selected according to the operator’s experience, the patient’s age, fertility desire, abscess size and spread, the patient’s risk factors, and clinical and laboratory results.
Medical Treatment, Surgical Treatment, Tubo-ovarian abscess, Pelvic Inflammatory Disease

Keywords

Medical Treatment, Surgical Treatment, Tubo-ovarian abscess, Pelvic Inflammatory Disease

59 Tuboovaryan Abse Olgusunun Klı̇nı̇k Yönetı̇mı̇

Abstract

Amaç: Retrospektif olarak, tubo-ovaryan abse (TOA) olgularının insidansını, risk faktörlerini, klinik ve laboratuvar sonuçlarını, komplikasyonlarını ve yönetim stratejilerini değerlendirmek.
Yöntem: Ocak 2016- Ocak 2021 yılları arasında, klinik ve sonografik olarak TOA tanısı ile kliniğimize yatışı yapılan 59 hastanın dosyası retrospektif olarak incelendi. Hastaların demografik verileri ve sonografik bulguları raporlandı. Hastaların klinik ve laboratuar sonuçları, uygulanan operasyon yöntemleri ve gelişen komplikasyonlar kaydedildi.
Bulgular: Hastaların ortalama yaşı 36.53 ∓ 9.26 idi. En sık pelvik ağrı (100%), vajinal akıntı (42,4%), ateş yüksekliği (35,6%) ve adet düzensizliği (30,5%) şikayetiyle başvuruldu. Ortalama abse boyutu 6.81 ∓ 2.08 [3-12] cm idi. Hastalar operasyon olanlar ve olmayanlar olarak iki gruba ayrıldı. Yirmi sekiz (47,5%) hastada sadece medikal tedavi yeterli olurken, 31 (52,5%) hastaya cerrahi tedavi uygulandı. Hastaların gravide, parite, BMI, evlilik süresi, PIH (pelvik inflamuar hastalık) öyküsü, geçirilmiş operasyon öyküsü ve ek sistemik hastalık açısından istatistiksel fark görülmedi. Rahim içi araç (RİA) varlığı ve kullanım süresi, TOA boyutu cerrahi yapılan grupta anlamlı olarak daha fazla bulundu. Sadece medikal tedavi uygulanan hastaların abse boyutları, operasyon gereken hastalara göre istatistiksel anlamlı olarak daha düşük saptandı (4.22 ∓ 1.94cm, 8.15 ∓ 2.28cm; p<0.001). Hastanede kalma süresi de medikal tedavi edilen grupta daha kısa idi (p:0.629). En sık cerrahi komplikasyon sırasıyla; mesane hasarı (12,9%), barsak perforasyonu (9,6%) ve üreter hasarı (9,6%) olarak gözlendi. Sadece bir hastanın patoloji sonucu malign olarak tespit edildi (3,2%).
Sonuç: TOA’nın erken tanı ve tedavisi, morbidite ve mortalite gibi hayatı tehdit eden ciddi sonuçları olmasından dolayı önemlidir. Operatör deneyimi, hastanın yaşı, fertilite arzusu, abse boyutu ve yayılımı, hastanın risk faktörleri, klinik ve laboratuvar sonuçlarına göre uygun tedavi yöntemi seçilmelidir.

Keywords

Cerrahi tedavi, Medikal tedavi, Pelvik inflamatuar hastalık, Tubo-ovaryen abse

References

• 1. Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039–2048.
• 2. Kim HY, Yang JI, Moon C. Comparison of severe pelvic inflammatory disease, Pyosalpinx and tubo-ovarian abscess. J Obstet Gynaecol Res. 2015;41:742–746.
• 3. Beigi RH, Wiesenfeld HC. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gyne- col Clin North Am 2003; (30):777-793. 4. Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009;23:667–678.
• 5. Lareau SM and Beigi RH. “Pelvic inflammatory disease and tubo-ovarian abscess”. Infectious Diseases Clinics of North America 22.4 (2008): 693-708. 6. Zhao WH, Hao M. Pelvic inflammatory disease: A retrospective clinical analysis of 1,922 cases in North China. Gynecol Obstet Invest. 2014;77:169–175. 7. Hiller N, Sella T, Lev-Sagi A, Fields S, Lieberman S. Computed tomographic features of tuboovarian abscess. J Reprod Med 2005;50(3):203-208.
• 8. Gencdal S, Aydogmus H. Evaluation of Surgical Treatment in Patients with Ruptured Tubo-Ovarian Abscess in Our Clinics. EC Gynaecology 4.6 (2017): 198-203.
• 9. Fouks, Y., Cohen, A., Shapira, U., Solomon, N., Almog, B., & Levin, I. Surgical intervention in patients with tubo-ovarian abscess: clinical predictors and a simple risk score. Journal of Minimally Invasive Gynecology, 2019;26(3), 535-543.
• 10. Granberg S, Gjelland K, Ekerhovd E. ‘’Best practice and research’’ Clinical Obstetrics and Gynecology, 2009; 23:667-678.
• 11. Centers for Disease Control and Prevention, Sexually Transmitted Diseases Treatment Guidelines, 2010.
• 12. Hsiao SM, Hsieh FJ, Lien YR. Tuboovarian abscesses in postmenopausal women. Taiwan J Obstet. Gynecol.2006;45(3):234-238.
• 13. Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 2012;55:893–903.
• 14. Reljic M, Gorisek B. C-reactive protein and the treatment of pelvic inflammatory disease. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 1998;60:143-150.
• 15. Curry, Amy, Tracy Williams, Melissa L. Penny K.. “Pelvic inflammatory disease: diagnosis, management, and prevention.” American family physician 2019;100.6:357-364.
• 16. Levin, G., Dior, U. P., Gilad, R. “Pelvic inflammatory disease among users and non-users of an intrauterine device.” Journal of Obstetrics and Gynaecology 41.1 (2021): 118-123.
• 17. Turan V, Yeniel Ö, Terek MC, Ulukuş M. Ege Üniversitesi Kadın Hastalıkları ve Doğum Kliniğinde Tuboovaryan Abselerin 5 Yıllık Değerlendirilmesi. Turkiye Klinikleri J Gynecol Obst 2009; 19:349-353.
• 18. Karakulak M, Aydın Y, Bahadır S, Güçlü S. Evaluation of the cases with tuboovarian abscesses. DEÜ Tip Fakültesi Dergisi. 2008; 22:9-13. 19. Dewitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalisation & complications? Obstetrics and gynecology international 2010;2010:847041.
• 20. Reed SD, Landers DV, Sweet RL. Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. American journal of obstetrics and gynecology. 1991;164:1556-1561.
• 21. Goje, O., Markwei, M., Kollikonda, S., Chavan, M., & Soper, D. E. “Outcomes of minimally invasive management of tubo-ovarian abscess: a systematic review.” Journal of minimally invasive gynecology 28.3 (2021): 556-564.
• 22. 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 Oct;193(4):1323-1330.
• 23. Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstetrical & gynecological survey. 2009;64:681-689.
• 24. Wagner A, Russell C, Ponterio JM, Pessolano JC. Ruptured tuboovarian abscess and septic shock with Clostridium perfringens in a postmenopausal woman: a case report. J Reprod Med. 2009;54(10):652-654.
• 25. Chu L, Ma H, Liang J, Li L, Shen A, Wang J, Li H, Tong X. Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study. Gynecol Obstet Invest. 2019;84(4):334-342.