Spontaneous Rupture of Tubo-Ovarial Abscess Into the Free Peritoneal Cavity

Abstract

The general use of antibiotics has resulted in a decrease in the incidence and severity of pelvic inflammatory disease. Nevertheless, patients with tubo-ovarial abscess are still being seen at Bellevue Hospital. Some of these abscesses rupture and result in severe generalized peritonitis that requires laparotomy. If the rupture is not diagnosed, the patient will die. The possibility of rupture into the free peritoneal cavity must constantly be borne in mind, as the prognosis depends primarily on the speed with which the diagnosis is made and the time interval between rupture and laparotomy.Of the 24 papers dealing with ruptured pelvic inflammatory masses that were published during the 16 years covered by this report, only 2 were concerned with ruptured tubo-ovarial abscesses. These reported a total of 51 cases. I do not feel, however, that this is a true estimate of the incidence of this condition. The fact that, except for the report of Miller 1 in 1945, no group of such cases has been presented from any large institution with a similar type of gynecologic service would strongly suggest that only a small percentage of these cases have been recognized or at least reported.

Treatment of acute non‐tuberculous salpingitis with antibiotics alone and in combination with glucocorticoids

“…Salpingitis should be treated conservatively and in hospital ( HEYNE-PINKERTON 1963, V~BERG 1964 a). The only exceptions to such conservative treatment are the rare cases with a ruptured pyosalpinx and general peritonitis, in which operation is life-saving (MILLER 1944, LINDE 1954, LARDARO 1954, DECH 1958. In addition salpingitis following radiotherapy for uterine cancer should be treated surgically (GORKJN 1957, K~~M E I E R 1959).…”

Tubo‐ovarian abscess in the postmenopausal woman

“…The latter reflect the changes in management from conservative medical treatment to aggressive operative intervention in women with ruptured TOA or pelvic abscesses unresponsive to antibiotics [1,[3][4][5][6][7][8][9][10][11][12][13][14][15]. Ten of 587 (1.7%) patients with TOA, described in 12 articles, were postmenopausal [3][4][5][6][7][8][9][10][11][12][13][14].In the past, the classical management of pelvic abscess was one of conservatism [15]. The indications for surgical intervention with an acute pelvic abscess were formerly quite limited [1]: (a) failure to respond to medical therapy; (b) a questionable diagnosis; (c) rupture; (d) evidence of an intraabdominal catastrophe; (e) associated suppurative…”

“…Therefore, the gynecologist and surgeon should be alert to this uncommon diagnosis in the elderly woman and be prepared for early surgical intervention.Tubo-ovarian abscesses (TOA) are considered a problem only during the childbearing years [1,2]. In the last century there have been numerous reports on the treatment of tubo-ovarian abscesses, most of them published in the last 30 years [1,[3][4][5][6][7][8][9][10][11][12][13][14]. The latter reflect the changes in management from conservative medical treatment to aggressive operative intervention in women with ruptured TOA or pelvic abscesses unresponsive to antibiotics [1,[3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…In the last century there have been numerous reports on the treatment of tubo-ovarian abscesses, most of them published in the last 30 years [1,[3][4][5][6][7][8][9][10][11][12][13][14]. The latter reflect the changes in management from conservative medical treatment to aggressive operative intervention in women with ruptured TOA or pelvic abscesses unresponsive to antibiotics [1,[3][4][5][6][7][8][9][10][11][12][13][14][15]. Ten of 587 (1.7%) patients with TOA, described in 12 articles, were postmenopausal [3][4][5][6][7][8][9][10][11][12][13][14].In the past, the classical management of pelvic abscess was one of conservatism [15].…”

Current Views on the Concept of Pelvic Inflammatory Disease

“…Today, death from PID is generally due to rupture of tuboovarian abscesses with a generalized peritonitis. In such cases, the mortality rate is still 8-9% (42,43).…”