View source for Tubo-ovarian abscess

==Background==
*Typically a complication of [[PID]], although inflammatory bowel, [[appendicitis]], and hematologic nidius have been reported 
*Mortality if not ruptured: <1% if treated; 2-4% if untreated
*Infections are often polymicrobial
**Common organisms: [[Escherichia coli]], aerobic streptococci, [[Bacteroides fragilis]], Prevotella, Peptostreptococcus
**[[N. gonorrhoeae]] and [[C. trachomatis]] are rarely culprit organisms

===Risk factors===
*Multiple sex partners
*Age 15-25 years old
*Prior history of [[PID]]
*[[IUD]] (within 21 days of insertion<ref>https://www.cdc.gov/std/tg2015/pid.htm</ref>)
*[[HIV]] infection

==Clinical Features==
*+/-[[Fever]]
*[[Vaginal discharge]]
*Dyspareunia
*Disproportionate unilateral adnexal tenderness or adnexal mass or fullness 
*Suspect in patient who does not respond after 72hr of treatment for [[PID]]

==Differential Diagnosis==
{{Pelvic pain DDX}}

==Evaluation==
[[File:PMC4603210 usg-15013-f11.png|thumb|Dilated, complex, fluid-filled tubular structure is consistent with hydro/pyosalpinx (A, B). Short-axis image (C) demonstrates the “cog-wheel” pattern of the endosalpingeal folds, indicative of tubal inflammation in pelvic inflammatory disease with a pyosalpinx or a hydrosalpinx. (arrows).]]
*CBC
*ESR/CRP
*Transvaginal pelvic ultrasound (Sn 75-82%)
*CT pelvis (Sn 78-100%) - preferred in patients in whom associated GI pathology must be excluded

==Management==
===Operative Drainage===
*OB/GYN consult for possible operative drainage
*Majority (60-80%) resolve with [[antibiotics]] alone
*Predictors of antibiotic treatment failure and possible indications for IR drainage upon admission to Ob<ref>Huma F et al. Inpatient Management of Tubo-Ovarian Abscesses: What Is the Threshold of Parenteral Antibiotic Treatment Failure? Obstetrics & Gynecology: May 2015</ref>
**WBC > 16,000
**TOA size > 5.2 cm

{{PID antibiotics}}

==Disposition==
*Decision should be made in conjunction with gynecological colleague
*Patient with fevers, elevated WBC, abscess greater than 5 cm, or systemic toxicity demand admission
*Hemodynamically stable, afebrile patients with a relatively small [[abscess]] can be safely discharged with close gynecological follow up on antibiotics

==See Also==
*[[PID]]

==References==
<references/>

[[Category:ID]]
[[Category:OBGYN]]