Tubo-ovarian abscess

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 pelvic inflammatory disease (PID) complication. 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 visualize the abscess better.

Although not commonly used, laparoscopy is still considered the definitive diagnostic tool and may allow for drainage and culture of the abscess.

Treatment

The first step in managing 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