Tubo-ovarian abscesses: A retrospective analysis of risk factors, clinical features, and treatments

Öz

Tubo-ovarian abscess (TOA) is a serious inflammatory disease of the female reproductive system including the ovary, fallopian tube, and the surrounding tissues. In this study, we aimed to present risk factors, clinical features and treatment approaches in TOA. The files of 31 patients with a diagnosis of TOA were analyzed retrospectively from January 2007 to June 2012. The patients' risk factors, clinical details, treatment modalities, laboratory results, and complications were recorded. The medically treated patients were divided into two groups: successful and unsuccessful treatment groups. Groups were compared according to the demographic data, risk factors, and mass characteristics. The mean age of patients was 33.12±10.43. Twenty-eight patients (90.3%) were married and 27 of them (87%) were multiparous. Intrauterine device (IUD) were used as contraceptive method in 11 of married patients (35.5%). Nine patients (29%) had history of prior intrauterine or intraabdominal intervention within 6 months. Pelvic inflammatory disease (PID) were in 15 patients (48.4%). At admission, pelvic pain in 31 (100%), vaginal discharge in 24 (77.4%), fever in 17 (54.8%), irregular menstrual bleeding in 14 (45.2%) of patients were recorded. Laboratory findings were elevated erythrocyte sedimentation rate (71%), and increased C-reactive protein level (71%), leukocytosis (61.3%) respectively. The initial diagnosis of hospitalized patients were observed TOA in 14 (45.2%), ruptured TOA in 5, IUD translocation and TOA in 7, the suspicion of a complication of perforated appendicitis in 1 and pelvic mass (teratoma, fibroid degeneration, ovarian cancer, endometrioma) in 4 of patients, respectively. Medical treatment was applied in 13 patients and reached 46.2% success rate. There was no significant difference in between successful and unsuccessful treatment groups with respect of demographic data, risk factors, and the mass characteristics. Surgical procedures were laparoscopic abscess drainage (22.6%), laparotomy and drainage of abscess (32.3%), unilateral salpingooopherectomy (12.9%), and total abdominal hysterectomy and bilateral salpingo-ooferectomy (12.9%), respectively. The bowel injury and sepsis (6.5%), dehiscence (6.5%), and wound infection (3.25%) were observed as postoperative complications. The pelvic masses may be a risk factor in addition to PID and the use of IUD for TOA. The patients with TOA may present with the pelvic mass and pelvic pain without the classic symptoms of infection. Therefore, TOA should be considered in the differential diagnosis of pelvic masses. Although the medical treatment should be the first choice in patients with TOA, suspected cases and ruptured abscesses should be treated by surgery.

Anahtar Kelimeler

• Medical treatment; pelvic mass; surgical treatment; tubo-ovarian abscess.

Tubo-ovaryan abseler: Risk faktörleri, klinik özellikler ve tedavilerinin retrospektif analizi

Öz

Tubo-ovaryan abse (TOA), tuba, over ve çevre dokuları içine alan ciddi bir inflamatuar hastalıktır. Bu çalışmada TOA’li olguların risk faktörleri, klinik bulguları ve tedavi yaklaşımlarını sunmayı amaçladık. Ocak 2007 – Haziran 2012 tarihleri arasında TOA tanısı ile takip edilen 31 hastaya ait dosyalar retrospektif olarak incelendi. Hastalara ait risk faktörleri, klinik ve laboratuar sonuçları, uygulanan tedavi yöntemleri ve gelişen komplikasyonlar kaydedildi. Medikal tedavi alan hastalar, başarılı ve başarısız tedavi grubu olarak iki gruba bölündü. Gruplar, demografik veriler, risk faktörleri ve kitle özelliklerine göre karşılaştırıldı. Hastaların ortalama yaşı 33.12±10.43 idi. Yirmisekizi (%90.3) evli ve 27’si (%87) multipardı. Kontraseptif yöntem olarak evli olan 28 hastanın 11’inde rahim içi araç (RİA) (%35.5) kullanımı mevcuttu. Son 6 ay içinde geçirilmiş intrauterin veya intraabdominal girişim veya operasyon 9 (%29) ve pelvik inflamatuar hastalık (PİH) 15 hastada (%48.4) mevcuttu. Hastaların başvuru sırasında, tümünde pelvik ağrı (%100), 24’ünde vajinal akıntı (%77.4), 17’sinde ateş (%54.8), 14’ünde düzensiz menstrüel kanama (%45.2) mevcut idi. TOA’lı hastalarda klinik bulgular olarak; %54.8 ateş, %61.3 lökositoz, %71 yüksek sedimentasyon hızı, %71 C-reaktif protein yüksekliği tespit edildi. Olguların hospitalize edildiklerindeki ilk tanıları; 14’ünde (%45.2) TOA, 5’inde rüptüre TOA, 7’sinde RİA translokasyonu ve TOA, 1’inde perfore apandisit komplikasyonu şüphesi, 4’ünde pelvik kitle (teratom, myom dejenerasyonu, over kanseri, endometrioma) idi. Medikal tedavinin 13 hastaya uygulandığı ve başarı oranının %46.2 olduğu bulundu. Başarılı ve başarısız tedavi grupları arasında, demografik veriler, risk faktörleri ve kitle özellikleri açısından anlamlı fark saptanmadı. Yapılan cerrahi girişimler; %22.6 laparoskopik abse drenajı, %32.3 laparotomi ile abse drenajı, %12.9 unilateral salpingoooferektomi ve %12.9 total abdominal histerektomi-bilateral salpingooferektomi idi. Postoperatif komplikasyon olarak %6.5 barsak hasarı ve sepsis, %6.5 dehisens ve %3.25 yara yeri enfeksiyonu geliştiği izlendi. TOA’de, PİH ve RİA kullanımı yanında pelvik kitleler de risk faktörü olabilir. TOA, klasik enfeksiyon semptomları olmaksızın pelvik kitle ve ağrı ile başvurabilir. Bu nedenle, pelvik kitle ayırıcı tanısında akla getirilmelidir. Tanısı TOA olan hastalarda ilk tedavi tercihi medikal; şüpheli olgularda ve rüptüre abselerde cerrahi olmalıdır.

Anahtar Kelimeler

• Cerrahi tedavi, medikal tedavi, pelvik kitle, tubo-ovaryan abse

Kaynakça

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