Percutaneous drainage of tubo-ovarian abscesses - Tips from Other Journals

Date: May, 1992

Tubo-ovarian abscesses have traditionally been treated with a trial of triple intravenous antibiotics, followed by surgery if antibiotic therapy failed. Since most tubo-ovarian abscesses occur in women of reproductive age, procedures that preserve reproductive function are desirable. Although percutaneous abscess drainage has been used with success in a variety of settings, it has only recently been used in the treatment of tubo-ovarian abscesses. Casola and colleagues report their experience with percutaneous drainage of tubo-ovarian abscesses in patients who failed to respond to intravenous antibiotic therapy.

The study included 16 patients between 14 and 40 years of age who had a tuboovarian abscess that failed to respond to an average of five days of intravenous antibiotic therapy. All of the patients presented with fever, pain and leukocytosis. Two patients had an intrauterine device in place, and three patients had a history of pelvic inflammatory disease. The abscesses were bilateral in 10 patients and unilateral in six. One patient had three abscesses.

Twenty-six of 27 abscesses were diagnosed with ultrasonography. The remaining case was diagnosed with computed tomography. (Gas in the collection made visualization with ultrasonography impossible. ) The access route for drainage was transvaginal in six patients, transgluteal in 11 patients, and through the anterior abdominal wall in 10 patients. Fine-needle aspiration alone was used in seven cases, and in the remaining cases, a catheter was placed for continued drainage.

Percutaneous drainage of tubo-ovarian abscesses was achieved in 15 of the 16 patients. One patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy because of persistent symptoms; this patient was found to have a large infected phlegmon. Catheters were left in place for one to 20 days (mean: six days). Complications included sciatica in two patients and transient bacteremia in one patient. Sciatica was associated with the transgluteal approach and resolved within a week after removal of the catheter. Two patients had recurrent tubo-ovarian abscesses three and four months after catheter drainage: one patient underwent bilateral salpingectomy, and the other patient had total abdominal hysterectomy and bilateral salpingo-oophorectomy.

The authors conclude that percutaneous drainage in women who have tubo-ovarian abscesses is a viable option if antibiotic treatment fails. In this study, surgery was avoided in 81 percent of patients. (Radiofogy, February 1992, vol. 182, p. 399. )

COPYRIGHT 1992 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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