Tuboovarian Abscess (TOA)

Review: Tuboovarian Abscess (TOA)

-sequela of acute salpingitis
-usually bilateral (unilateral is not rare)

1. symptoms
-similar to symptoms of acute salpingitis
-pain and fever have often been present for longer than 1 week
-ruptured TOA: life-threatening surgical emergency
? gram-negative endotoxic shock

2. signs
-palpated on bimanual examination as very firm, exquisitely tender, bilateral fixed masses
-can be palpated in the pelvic cul-de-sac

3. diagnosis
-by ultrasonography
-DDx(of a unilateral mass): adnexal torsion, endometrioma, leaking ovarian cyst, periappendiceal abscess
-laparoscopy or laparotomy (if P/E & ultrasound results are not definitive)

4. mamagement
① unruptured TOA
: intravenous antibiotics
: close monitoring to detect leakage or impending rupture
②ruptured TOA
: tachycardia, rebound tenderness (diffuse peritonitis)
? hypotension, oliguria
: exploratory laparotomy with resection of infected tissue