{"id":4138,"date":"2019-12-31T01:00:22","date_gmt":"2019-12-31T06:00:22","guid":{"rendered":"https:\/\/obgconnect.com\/library\/?p=4138"},"modified":"2024-12-29T17:43:03","modified_gmt":"2024-12-29T22:43:03","slug":"tubo-ovarian-abscess-toa","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/library\/2019\/12\/31\/tubo-ovarian-abscess-toa\/","title":{"rendered":"Tubo-ovarian abscess (TOA)"},"content":{"rendered":"\n<ul class=\"wp-block-list\">\n<li><a href=\"#key-points\">Key Points<\/a><\/li>\n\n\n\n<li><a href=\"#background\">Background<\/a>\n<ul class=\"wp-block-list\">\n<li><a href=\"#etiology\">Etiology<\/a><\/li>\n\n\n\n<li><a href=\"#symptoms\">Symptoms<\/a><\/li>\n\n\n\n<li><a href=\"#diagnosis\">Diagnosis<\/a><\/li>\n\n\n\n<li><a href=\"#medical-treatment\">Medical Treatment<\/a><\/li>\n\n\n\n<li><a href=\"#medical-treatment-failure\">Medical Treatment Failure<\/a><\/li>\n\n\n\n<li><a href=\"#long-term-sequelae\">Long Term Sequelae<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"#primary-sources\">Primary Sources<\/a><\/li>\n\n\n\n<li><a href=\"#professional-recommendations\">Professional Recommendations<\/a><\/li>\n\n\n\n<li><a href=\"#references\">References<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/obgconnect.com\/library\/2020\/03\/29\/labor-and-delivery-table-of-contents\/\"><strong>ObG L&amp;D<\/strong> Table of Contents<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"key-points\">KEY POINTS:&nbsp;<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tubo-ovarian abscess is an infectious\u00a0complex\u00a0in one adnexa or both\n<ul class=\"wp-block-list\">\n<li>Can\u00a0involve structures beyond the tube and ovary, including bowel and bladder\u00a0\u00a0<\/li>\n\n\n\n<li>Most commonly from a\u00a0polymicrobial\u00a0ascending genital tract infection\u00a0\u00a0\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>TOA commonly presents with abdominal pain, fever, leukocytosis and vaginal discharge and, if severe,\u00a0can be life-threatening\u00a0\u00a0<\/li>\n\n\n\n<li>Differential includes\n<ul class=\"wp-block-list\">\n<li>Appendicitis\u00a0| Diverticulitis\u00a0| Ovarian torsion\u00a0|\u00a0IBD\u00a0|\u00a0Ectopic pregnancy\u00a0| Ovarian mass\u00a0| Pyelonephritis\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Historically, IUD was thought to be an independent risk\u00a0factor\n<ul class=\"wp-block-list\">\n<li>Recent studies\u00a0negate\u00a0IUD as an independent risk\u00a0factor\u00a0\u00a0<\/li>\n\n\n\n<li>Only\u00a0slightly\u00a0increased\u00a0risk at the time of insertion\u00a0and subsequent\u00a01\u00a0to\u00a03\u00a0weeks\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Untreated TOA can result in sepsis, tissue necrosis and agglutination of pelvic structures causing long term scarring and adhesive\u00a0disease\u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Note:&nbsp;<\/strong>TOA requires urgent inpatient<strong>&nbsp;<\/strong>medical treatment&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"background\">BACKGROUND:&nbsp;<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"etiology\">Etiology&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tubo-ovarian abscesses\u00a0commonly result from a lower genital tract infection making its way from vagina or cervix into the uterus and then out to fallopian tubes and ovaries\u00a0<\/li>\n\n\n\n<li>Common organisms include\n<ul class=\"wp-block-list\">\n<li>E. coli\u00a0|\u00a0Streptococci\u00a0|\u00a0Prevotella\u00a0| Bacteroides\u00a0|Peptostreptococcus\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Rare organisms include\n<ul class=\"wp-block-list\">\n<li>Mycobacterium | Actinomyces | Gonorrhea | Chlamydia\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The infection\u00a0is almost always polymicrobial\u00a0<\/li>\n\n\n\n<li>Most often a consequence of untreated PID<\/li>\n\n\n\n<li>Risk Factors include\n<ul class=\"wp-block-list\">\n<li>Reproductive ages between 15\u00a0to\u00a040 |\u00a0Sexually active |\u00a0Prior history of PID | Rarely, can occur in postmenopausal patients and in patients without risk factors\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"symptoms\">Symptoms<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Acute onset of abdominal pain localized to lower quadrants\u00a0|\u00a0often worse with coitus or movements\n<ul class=\"wp-block-list\">\n<li>Systemic signs:\u00a0Fever\u00a0| Leukocytosis\u00a0| Nausea\u00a0| Dysuria\u00a0| Vaginal discharge and\/or bleeding\u00a0\u00a0\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Fitz-Hugh-Curtis:\u00a0Rare, right upper quadrant pain worse with movement or breathing indicates disease that affects the peritoneum and adhesions on the liver\u00a0capsule\u00a0\u00a0<\/li>\n\n\n\n<li>Symptoms can be subtle and fever is sometimes not present\u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>PID without TOA&nbsp;<\/em>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ascending infection but has not yet resulted in abscess of the tubes or ovaries\u00a0<\/li>\n\n\n\n<li>Managed outpatient unless the following is present\n<ul class=\"wp-block-list\">\n<li>Surgical emergency such as appendicitis cannot be ruled out\u00a0<\/li>\n\n\n\n<li>Pregnancy (early, after 12 weeks of pregnancy ascending infection is unlikely and appendicitis should be the lead differential)\u00a0<\/li>\n\n\n\n<li>Severe illness with nausea, vomiting and high fever\u00a0\u00a0<\/li>\n\n\n\n<li>Not responsive to oral treatment\u00a0\u00a0<\/li>\n\n\n\n<li>Unable to follow or tolerate an outpatient regimen\u00a0<\/li>\n\n\n\n<li>Not responding to oral antimicrobial treatment\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis&nbsp;&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Physical Exam findings\n<ul class=\"wp-block-list\">\n<li>Abdominal Exam |\u00a0Tenderness to palpation in right\/left or bilateral lower quadrants, rebound,\u00a0guarding,\u00a0or\u00a0distension of the abdomen\u00a0\u00a0<\/li>\n\n\n\n<li>Pelvic Exam |\u00a0Exquisite cervical motion tenderness\u00a0| Cervical mucopurulent discharge, pain on pelvic exam\u00a0<\/li>\n\n\n\n<li>If a ruptured TOA, patient can present with rigid abdomen and signs of sepsis\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Laboratory Studies\n<ul class=\"wp-block-list\">\n<li>Pregnancy test to rule out ectopic | CBC to assess leukocytosis |\u00a0Blood cultures if concern for sepsis |\u00a0Gonorrhea and chlamydia (from urine or cervix)\u00a0<\/li>\n\n\n\n<li>Can consider erythrocyte sedimentation rate or c-reactive protein to confirm bacterial infection\u00a0<\/li>\n\n\n\n<li>Possible endometrial biopsy if group A strep suspected\u00a0or saline vaginal microscopy to confirm white cells\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Imaging Studies\n<ul class=\"wp-block-list\">\n<li>Ultrasound (transvaginal or abdominal) will show multilocular and complex\u00a0tubo-ovarian masses or complexes with debris, septations and irregular wall thickness with possible debris in the pelvis\u00a0<\/li>\n\n\n\n<li>CT (better when excluding appendicitis or other gastrointestinal etiology) demonstrating fluid-filled\u00a0tubo-ovarian masses and thickened walls\u00a0<\/li>\n\n\n\n<li>MRI similar findings to CT\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"medical-treatment\">Medical&nbsp;Treatment&nbsp;&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><em>CDC Guidelines for&nbsp;First-Line&nbsp;Parenteral Treatment<\/em>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ceftriaxone\u00a01 g IV every 24 hours PLUS doxycycline\u00a0100 mg orally or IV every 12 hours PLUS metronidazole\u00a0500 mg orally or IV every 12 hours<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">OR<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cefotetan\u00a02 g IV every 12 hours PLUS doxycycline\u00a0100 mg orally or IV every 12 hours<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">OR<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cefoxitin\u00a02 g IV every 6 hours PLUS doxycycline\u00a0100 mg orally or IV every 12 hours<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>CDC Alternative Parenteral Regimens<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ampicillin-sulbactam\u00a03 g IV every 6 hours PLUS doxycycline\u00a0100 mg orally or IV every 12 hours<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">OR<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clindamycin\u00a0900 mg IV every 8 hours PLUS gentamicin\u00a0loading dose IV or IM (2 mg\/kg body weight), followed by a maintenance dose (1.5 mg\/kg body weight) every 8 hours | Single daily dosing (3\u20135 mg\/kg body weight) can be substituted<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>After Hospitalization&nbsp;Discharge&nbsp;and&nbsp;Outpatient&nbsp;Considerations<\/em>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Transition to outpatient regimen following clinical improvement to complete 14 days of therapy <\/li>\n\n\n\n<li>Following first-line parenteral treatment\n<ul class=\"wp-block-list\">\n<li>Doxycycline 100 mg 2 times\/day and metronidazole 500 mg 2 times\/day <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If using clindamycin and gentamicin alternative parenteral regimen\n<ul class=\"wp-block-list\">\n<li>Clindamycin (450 mg orally 4 times\/day) or metronidazole (500 mg orally 2 times\/day) should be used to complete 14 days of therapy with oral doxycycline<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Discharge criteria\u00a0following inpatient admission\n<ul class=\"wp-block-list\">\n<li>Afebrile for 24\u00a0to\u00a048 hours and able to meet activities of daily living\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Quinolone agents\n<ul class=\"wp-block-list\">\n<li>Due to quinolone-resistant N. gonorrhoeae, regimens with a quinolone agent are no longer routinely recommended for treatment\u00a0\u00a0\u00a0\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"medical-treatment-failure\">Medical Treatment Failure<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Proceed to surgical management if medical management fails<\/li>\n\n\n\n<li>Signs of failed medical management include\n<ul class=\"wp-block-list\">\n<li>Signs of sepsis including respiratory or cardiac compromise\u00a0or persistent fever\u00a0\u00a0<\/li>\n\n\n\n<li>Mass enlarging or markedly more painful\u00a0\u00a0<\/li>\n\n\n\n<li>Concern for malignancy\u00a0especially in postmenopausal women presenting with presumed TOA\u00a0<\/li>\n\n\n\n<li>Group A Strep infection requires hysterectomy (can be diagnosed on culture or endometrial biopsy)\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Percutaneous Drainage versus Surgical (<\/em><em>Laparoscopy<\/em><em>&nbsp;<\/em><em>or Laparotomy)<\/em>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Percutaneous drainage has higher success rates if TOA is unilocular vs multilocular\u00a0<\/li>\n\n\n\n<li>Laparotomy versus laparoscopy dependent on the skills and preference of the surgeon\n<ul class=\"wp-block-list\">\n<li>Obtain anaerobic and aerobic cultures\u00a0<\/li>\n\n\n\n<li>Remove as much of the abscess cavity and surrounding debris\u00a0\u00a0<\/li>\n\n\n\n<li>Irrigate throughout the peritoneal cavity\u00a0\u00a0<\/li>\n\n\n\n<li>May consider a TAH\/BSO in patient who has completed childbearing\u00a0<\/li>\n\n\n\n<li>Close fascia with monofilament non-absorbable or delayed-absorbable suture and place closed suction drain like a Jackson-Pratt until fluid collection from drainage is minimal\u00a0\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"long-term-sequelae\"><em>Long Term Sequelae<\/em>&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infertility, increased risk for ectopic pregnancy, pelvic thrombosis and chronic pelvic pain due to adhesive disease.\u00a0\u00a0<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"primary-sources\">PRIMARY SOURCES:&nbsp;&nbsp;<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Gil et al.&nbsp;Tubo-ovarian abscess in postmenopausal women: A systematic review.&nbsp;Gynecol&nbsp;Obstet&nbsp;Hum&nbsp;Reprod. 2020&nbsp;&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This systematic review&nbsp;assessed&nbsp;9 studies&nbsp;to determine the&nbsp;prevalence rate of TOA in postmenopausal women&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Results\n<ul class=\"wp-block-list\">\n<li>The prevalence of TOA in this population was\u00a06%\u00a0to\u00a018%\u00a0\u00a0<\/li>\n\n\n\n<li>Most common risk factor was a recent endometrial biopsy or a longstanding IUD (reported in up to 50% of cases)\u00a0<\/li>\n\n\n\n<li>The rate of patients presenting with TOA and eventually diagnosed with malignancy varied from 2.5% to 47%\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Goje et al. J Minim Invasive&nbsp;Gynecol, 2020&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This&nbsp;systematic review&nbsp;assessed 10 studies to&nbsp;compare conservative management of TOA with antibiotics versus image-guided drainage versus laparoscopic drainage&nbsp;in a cohort of 975 patients&nbsp;&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Results\n<ul class=\"wp-block-list\">\n<li>Laparoscopic\u00a0drainage:\u00a011%\u00a0\u00a0<\/li>\n\n\n\n<li>Image-guided drainage:\u00a042%\u00a0\u00a0<\/li>\n\n\n\n<li>Conservative management:\u00a047%\u00a0\u00a0<\/li>\n\n\n\n<li>Authors found image-guided TOA drainage had the highest success,\u00a0the lowest complication rate,\u00a0and the shortest hospital stay\u00a0\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Shigemi&nbsp;et al.&nbsp;Obstet&nbsp;Gynecol,&nbsp;2019&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This&nbsp;retrospective cohort study&nbsp;compared laparoscopy vs&nbsp;laparotomy to manage patients with&nbsp;severe PID, including those with TOA&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Results\n<ul class=\"wp-block-list\">\n<li>27,841 patients with PID\u00a0|\u00a0749 women\u00a0had\u00a0laparoscopy\u00a0and\u00a03,670 had laparotomy\u00a0<\/li>\n\n\n\n<li>Laparoscopic group had shorter operation duration, fewer blood transfusions, and shorter length of hospital stay\u00a0vs\u00a0laparotomy group\u00a0<\/li>\n\n\n\n<li>There were no significant differences between groups for in-hospital deaths, surgical complications, and revision surgery\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Fouks&nbsp;et al. J Minim Invasive&nbsp;Gynecol,&nbsp;2019&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The authors of this&nbsp;retrospective cohort study&nbsp;constructed a clinical risk score for TOA conservative treatment failure&nbsp;using a cohort of&nbsp;of&nbsp;335 patients diagnosed with a TOA&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Results\n<ul class=\"wp-block-list\">\n<li>Their validated risk factors determined predictive of conservative treatment failure were: Age\u00a0&gt;35\u00a0|\u00a0WBC count level &gt; 16k\u00a0| Largest\u00a0TOA\u00a0diameter &gt;7cm\u00a0| Presence of bilateral abscess on admission\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"professional-recommendations\">PROFESSIONAL RECOMMENDATIONS:\u202f<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">ACOG&nbsp;Practice Bulletin 174&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Aspiration of an adnexal mass may be appropriate in cases of\u00a0tubo-ovarian abscess (although antibiotic therapy is first-line treatment) <\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">CDC&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>TOA necessitates\u00a0inpatient management\u00a0<\/li>\n\n\n\n<li>Parenteral antibiotics should continue for 24 to 48 hours, or until afebrile and clinically improved\u00a0<\/li>\n\n\n\n<li>Outpatient antibiotics should include metronidazole or clindamycin in addition to doxycycline to facilitate anaerobic coverage for minimum 14 days\u00a0<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"references\">REFERENCES: <\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/pid.htm\" target=\"_blank\" rel=\"noreferrer noopener\">CDC:&nbsp;Pelvic Inflammatory Disease (PID)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-bulletin\/articles\/2016\/11\/evaluation-and-management-of-adnexal-masses\" target=\"_blank\" rel=\"noreferrer noopener\">ACOG Practice Bulletin 174: Evaluation and Management of Adnexal Masses<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29966713\/\" target=\"_blank\">Surgical Intervention in Patients with&nbsp;Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score (Fouks&nbsp;et al. J Minim Invasive&nbsp;Gynecol, 2019)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15841934\/\" target=\"_blank\">Computed tomographic features of&nbsp;tuboovarian&nbsp;abscess (Hiller et al. J&nbsp;Reprod&nbsp;Med, 2005)&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30612130\/\" target=\"_blank\">Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for&nbsp;Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study (Chu et al.&nbsp;Gynecol&nbsp;Obstet&nbsp;Invest, 2019)&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19772677\/\" target=\"_blank\">Tubo-ovarian abscess management options for women who desire fertility (Rosen et al.&nbsp;Obstet&nbsp;Gynecol&nbsp;Surv, 2009)&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23090458\/\" target=\"_blank\">Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and&nbsp;tuboovarian&nbsp;abscess (Chappell et al. Clin&nbsp;Obstet&nbsp;Gynecol, 2012)&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/8807761\/\" target=\"_blank\">Early ultrasound-guided transvaginal drainage of&nbsp;tubo-ovarian abscesses: a randomized study&nbsp;(Perez-Medina et al.&nbsp;Ultrasound&nbsp;Obstet&nbsp;Gynecol,&nbsp;1996)&nbsp;&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32992023\/\" target=\"_blank\">Outcomes of Minimally Invasive Management of&nbsp;Tubo-ovarian Abscess: A Systematic Review&nbsp;(Goje&nbsp;et al.&nbsp;J Minim Invasive&nbsp;Gynecol,&nbsp;2020)<\/a>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32413520\/\" target=\"_blank\">Tubo-ovarian abscess in postmenopausal women: A systematic review. (Gil <em>e<\/em>t al. J&nbsp;Gynecol&nbsp;Obstet&nbsp;Hum&nbsp;Reprod, 2020)&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31135738\/\" target=\"_blank\">Laparoscopic Compared&nbsp;With&nbsp;Open Surgery for Severe Pelvic Inflammatory Disease and&nbsp;Tubo-Ovarian Abscess (Shigemi&nbsp;et al.&nbsp;Obstet&nbsp;Gynecol, 2019)&nbsp;&nbsp;<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tubo-ovarian abscess is an infectious complex in one adnexa or both. <\/p>\n","protected":false},"author":1252,"featured_media":4185,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[91],"tags":[109,89,84,112,111,110],"class_list":["post-4138","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gyn","tag-adnexal-masses","tag-ectopic","tag-ectopic-pregnancy","tag-pelvic-pain","tag-pid","tag-tuboovarian-abcess"],"acf":[],"featured_image_urls_v2":{"full":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752-150x150.jpg",150,150,true],"medium":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752-300x199.jpg",300,199,true],"medium_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-768x556.jpg",640,463,true],"large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-1024x741.jpg",640,463,true],"1536x1536":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-1536x1111.jpg",1536,1111,true],"2048x2048":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"ultp_layout_landscape_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"ultp_layout_landscape":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"ultp_layout_portrait":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"ultp_layout_square":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"woocommerce_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752-300x265.jpg",300,265,true],"woocommerce_single":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752.jpg",399,265,false],"woocommerce_gallery_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2019\/12\/Screen-Shot-2021-03-31-at-3.22.48-PM-e1617218925752-100x100.jpg",100,100,true]},"post_excerpt_stackable_v2":"<p>Tubo-ovarian abscess is an infectious complex in one adnexa or both. <\/p>\n","category_list_v2":"<a href=\"https:\/\/obgconnect.com\/library\/category\/labor-and-delivery\/gyn\/\" rel=\"category tag\">GYN Emergencies<\/a>","author_info_v2":{"name":"jcomfort","url":"https:\/\/obgconnect.com\/library\/author\/jcomfort\/"},"comments_num_v2":"0 comments","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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