Tubo-ovarian abscess

Definition

• Tubo-ovarian abscess is a severe complication of pelvic inflammatory disease with adnexal inflammation, typically involving a pus-filled tube and ovary, caused by an ascending infection.
• As the full-blown manifestation of PID, progression of infection destroys the normal adnexal structure and an inflammatory mass encompassing tube and ovary forms.

Occurrence & epidemiology

Epidemiology

• Tubo-ovarian abscess develops in up to about 15% of patients with PID or salpingitis and mainly affects sexually active women of reproductive age; it may also occur without other PID sequelae.
• It can accompany acute or chronic infection and is sometimes bilateral.

Clinical features

Clinical features and imaging

• Clinical signs: Indicative of adnexitis are bilateral pain, fever, vaginal discharge, cervical motion tenderness and elevated inflammatory markers.
• Tubo-ovarian abscess: A tubo-ovarian abscess appears as a complex cystic-solid adnexal mass.

Clinical features and complications

• Common symptoms are fever, abdominal pain and foul-smelling discharge, although the presentation varies widely.
• Pain, fever and peritoneal signs are usually present and may be severe; a palpable adnexal mass suggests tubo-ovarian abscess.
• The abscess can cause systemic infection and involve neighbouring organs such as bowel or bladder; rupture can lead to life-threatening sepsis and septic shock.
• Sequelae are infertility, chronic pelvic pain and an increased risk of ectopic pregnancy.

Diagnosis

• Ultrasound and CT are used to detect the abscess.
• CT shows a mixed solid-cystic adnexal mass with complex fluid and thickened, irregularly enhancing walls and septa; the mesosalpinx is often thickened.
• On MRI the septa and the thickened wall enhance, and the wall, septa and purulent content show restricted diffusion.
• Identification of a dilated, pus-filled tube allows differentiation from a complex adnexal tumour.

Keep learning in the app

Further reading (selection)

1. StatPearls: Tubo-Ovarian Abscess (NCBI Bookshelf)
2. MSD Manual Professional: Pelvic Inflammatory Disease (PID)
3. DocCheck Flexikon, Ovarialtorsion

Cross-references