Small bowel obstruction and perforation attributed to tubo-ovarian abscess following 'D’ and 'C’

Weledji, Elroy Patrick; Elong, Felix Adolphe

doi:10.1186/1749-7922-8-41

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Surgical procedures of the female genital tract, abdominal, or vaginal, place the patient at increased risk for PID, with ~15% of pelvic infections occurring after procedures that break the cervical mucus barrier. 18 , 19 Such infections have been reported after dilatation and curettage, 18 , 19 oocytes vaginal retrieval for IVF, 19 , 20 Essure insertions even few years later with Essure acting either as a nidus or as a conduit for infection, 21 and pipelle sampling. 19 …”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study

Habboub¹

2016

IJWH

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AimThe aim of this paper was to study the characteristics of patients presenting to Middlemore Hospital with tubo-ovarian abscess (TOA) and to compare the outcomes of conservative medical management versus medical management with surgical drainage and medical management with radiological drainage.MethodsAll patients admitted with a radiologically or surgically proven TOA between January 01, 2008 and December 31, 2010, were included and followed up until June 30, 2011. The total number of patient/index admission was 174.ResultsThe mean age of patients was 37.8 years. One hundred thirty patients had medical treatment only with hospitalization and antibiotics, and 44 patients were managed with antibiotics and surgical drainage. Complete resolution of TOA was 77.3% (99/128) for patients managed medically and 93.2% (41/44) for patients managed surgically. When the two groups were compared, patients who were managed surgically were more likely to have complete resolution of TOA within 6 months of index admission with an odds ratio (OR) of 4 and a P-value of 0.029. There was no statistically significant difference in the secondary outcomes namely of readmission with TOA (OR: 0.47) and the need for repeat surgical or radiological drainage (OR: 1.48). Nonetheless, the relative duration of hospitalization was longer for the surgical group with a P-value of <0.0001. The C-reactive protein and the size of TOA were the significant factors involved in the resolution of TOA.ConclusionThe results of this study confirmed our initial hypothesis that we should consider surgical drainage more often, probably earlier, especially for the younger patients still desiring fertility preservation and for larger abscesses. Laparoscopic surgical drainage is safe and could be used as the procedure of choice. Conservative medical management is still acceptable with good cure rates of 77%. C-reactive protein and the size of the abscess were the important factors to consider when managing patients with TOA.

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Section: Discussion and Review Of Literaturementioning

confidence: 99%

Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study

Habboub¹

2016

IJWH

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“…Intussusception in adults is rare and always require a laparotomy as it is commonly due to an underlying malignancy such as lymphoma or carcinoma. Any inflammatory mass such as diverticular, appendiceal, tubo-ovarian ileo-caecalCrohn'setc, may cause small bowel obstruction by blocking the ileocaecal valve or by causing a localized ileus [18,19]. The narrowest part of the small bowel is the terminal ileum which is the preferred site of obstruction by most of the luminal causes.…”

Section: Aetiology Of Small Bowel Obstructionmentioning

confidence: 99%

Perspectives on Mechanical Small Bowel Obstruction in Adults

Weledji¹

2017

ARGH

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Small bowel obstruction is a serious and costly medical condition indicating often emergency surgery. Delay in operative intervention may lead to an unnecessary bowel resection, an increased risk of perforation and an overall worsening of patient morbidity and mortality. A thorough history and examination would distinguish simple from strangulation obstruction and facilitate appropriate management. The article reviewed small bowel obstruction and emphasized the importance of history taking and examination in the early diagnosis of its cause, thus, facilitating appropriate management.

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“…In patients whose comorbidities may predispose them to worse outcomes if complications arise (i.e., poor glycemic control, immunodeficiency, poor nutritional status), a more aggressive initial approach may be appropriate. In addition, maintaining a high level of concern about the involvement of adjacent structures including the large and small bowels should be upheld throughout their care, even after initial management [ 8 ]. LBOs are surgical emergencies and require close observation of the cecum as its intrinsic characteristics make it particularly susceptible to perforation.…”

Section: Discussionmentioning

confidence: 99%

Cecal Perforation Secondary to Large Bowel Obstruction From a Tubo-Ovarian Abscess

DeBlieux¹,

Herron²

2022

Cureus

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With the continued specialization of medicine, we as physicians often fall into the trap of placing pathologies into silos, focusing on what we are most practiced in caring for. When managing acute patients, it is important that we consider complications that can arise across systems and specialties which could place our patients at increased risk for morbidity and mortality. Tubo-ovarian abscesses (TOAs) are complex infections often arising in the setting of pelvic inflammatory disease. The resultant reactive inflammation is frequently the culprit of potentially fatal sequelae. This article looks to highlight a case of TOA that resulted in inflammation and obstruction of the adjacent large bowel which subsequently led to large bowel obstructions (LBOs) and perforation. Although LBO management is well described in the literature, perforation secondary to inflammatory compression from a TOA is rarely documented.We present the case of a middle-aged female with significant comorbid conditions and recent prolonged retention of a tampon which likely acted as the nidus for the infection that led to her presenting pathology and need for admission, a left-sided TOA measuring 8.1 × 4.7 × 3.4 cm. Consultation by obstetricsgynecology and interventional radiology determined that admission for observation and intravenous antibiotics alone was appropriate. The patient's hospital course was complicated by enlarging TOA with peri-colonic abscess and acute decompensation in the setting of LBO and cecal perforation. Emergency laparotomy and right hemicolectomy by the acute care surgical team were performed. Postoperative management was complicated by septic shock which prolonged her hospital stay. Following inpatient optimization of nutrition and management of comorbid conditions, the patient was able to make a full recovery.In patients with suspected TOA, special consideration should be given to surrounding structures, and potentially fatal complications should be kept in the forefront of the primary team's minds. This case report aims to urge physicians caring for patients with TOA to maintain a high level of suspicion and consider how the benefits of aggressive management may outweigh those of conservative options.

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Small bowel obstruction and perforation attributed to tubo-ovarian abscess following 'D’ and 'C’

Cited by 7 publications

References 12 publications

Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study

Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study

Perspectives on Mechanical Small Bowel Obstruction in Adults

Cecal Perforation Secondary to Large Bowel Obstruction From a Tubo-Ovarian Abscess

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