The value of ultrasonographic tubo‐ovarian abscess morphology in predicting whether patients will require surgical treatment

Kinay, Tugba; Ünlübilgin, Eylem; Cırık, Derya Akdağ; Kayıkçıoğlu, Fulya; Akgül, Mehmet Akif; Dölen, İsmail

doi:10.1016/j.ijgo.2016.04.006

Cited by 43 publications

(39 citation statements)

References 14 publications

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“…Increased age, a high WCC and a cyst >6 cm in size are thought to be associated with an increased risk for surgery 11. In our case, all three of these conditions were present.…”

Section: Discussionsupporting

confidence: 48%

Sepsis Secondary toBacteroides FragilisTubo-Ovarian Abscess Requiring Hysterectomy and Bilateral Salpingo-Oophorectomy

Feuerstein¹,

O’Gorman

Jakus

2018

BMJ Case Reports

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A 45-year-old, G0P0 premenopausal woman was admitted for investigation of right lower quadrant pain, fever, leucocytosis and right adnexal abscess on CT. She was started on intravenous antibiotics and underwent CT-guided percutaneous drainage from which was cultured. A few days later, she had an exploratory laparotomy with incision and drainage. Once stabilised, she was discharged on intravenous antibiotics. She was followed outpatient and subsequent imaging demonstrated significant improvement of the abscess. After being asymptomatic for 3 months, she again presented to the emergency department with right lower quadrant abdominal pain, fever and leucocytosis. Two days later, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. She made a full recovery and began treatment with a herbal oestrogen derivative to prevent early menopause.

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“…Increased age, a high WCC and a cyst >6 cm in size are thought to be associated with an increased risk for surgery 11. In our case, all three of these conditions were present.…”

Section: Discussionsupporting

confidence: 48%

Sepsis Secondary toBacteroides FragilisTubo-Ovarian Abscess Requiring Hysterectomy and Bilateral Salpingo-Oophorectomy

Feuerstein¹,

O’Gorman

Jakus

2018

BMJ Case Reports

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“…Roberts et al recom- mended [18] immediate laparoscopy since they observed an initial response of 20-87% with medical management as opposed to 90-100% with early laparoscopy. Several studies examined the risk factors of surgery after failed medical treatment for TOA patients, and the consensus was that abscess size is an important predictive index of antibiotic treatment failure [5,[19][20][21]. In those studies, abscess diameter of ≥5-6.5 cm was a significant parameter that increased the risk for surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, studies of the pregnancy outcomes of pelvic abscess and TOA are rare. In the present study, pregnancy outcomes could not be evaluated, but more bilateral adhesions were found in the late [6,26,27], parity [19,26,28], high levels of WBC [6,26,29], high levels of CRP [20], and smoking [6] as high risk factors for failure to conservative treatment in patients with pelvic abscesses. In contrast to those findings, Topcu et al [5] and Mizushima et al [30] reported that age, levels of WBC and CRP, gravida, parity, body temperature, and rate of smoking were not high risk factors predicting antibiotic therapy failure.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

Chu

Liang

et al. 2019

Gynecol Obstet Invest

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Background/Aim: We aimed to assess the value of early laparoscopic therapy in management of tubo-ovarian abscess (TOA) or pelvic abscess. Methods: This was a retrospective study of all consecutive patients who were initially diagnosed with TOA or pelvic abscess at the local hospital between January 2010 and December 2014. The risks of operation and recurrence were analyzed using logistic analyses. Results: The durations of body temperature > 38.0°C (p = 0.001) and hospitalization (p < 0.001) were longer in the conventional group versus the early laparoscopy group. In the conventional group, 15 (50%) patients finally underwent laparoscopic exploration. The abscess size in the late laparoscopic group was significantly larger than the successful antibiotic treatment group (6.3 ± 1.5 vs. 4.9 ± 1.2 cm, p = 0.010). Abscess > 5.5 cm was independently associated with antibiotic failure (OR 4.571; 95% CI 1.612–12.962). Compared with late laparoscopy, early laparoscopy was associated with a shorter operation time (p = 0.037), less blood loss (p = 0.035), and shorter durations of body temperature > 38.0°C (p < 0.001) and hospitalization (p < 0.001). The cost was the lowest in the patients successfully treated conservatively. Conclusion: Early laparoscopic treatment is associated with shorter time of fever resolution, shorter hospitalization, and less blood loss compared with conventional treatment for TOA or pelvic abscess.

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“…Early surgical intervention can reduce morbidity and mortality in TOA patients who do not respond to antibiotics. Several studies of demographic and clinical characteristics associated with antibiotic treatment failure in TOA patients have shown that the TOA size and age of the patient are significantly related and proportional to the need for surgical treatment (6)(7)(8)(9)(10)(11). Early recognition of a patient's risk of antibiotic treatment failure alerts clinicians to the need to change the treatment strategy, thereby reducing acute and long-term complications of TOA.…”

Section: Discussionmentioning

confidence: 99%

The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang

Kim

2020

Preprint

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Background: The prediction of antibiotic treatment failure is helpful to identify patients with a high likelihood of needing surgical treatment early in patients diagnosed with tubo-ovarian abscess (TOA). The aim of this study was to compare the clinical characteristics of patients with TOA) who responded to medical treatment and those who underwent surgical intervention due to medical treatment failure. Material and Methods: Electronic medical records were evaluated retrospectively to identify patients who were diagnosed with TOA and hospitalized in our obstetrics and gynecology department between March 2014 and June 2019. Demographic, clinical, and laboratory data including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared between the medical treatment group and the surgical intervention group. Logistic regression was used to determine the independent predictors of treatment failure. Results: Patient age, TOA diameter, WBC count, CRP, and ESR were significantly different between the groups. On multiple regression analysis, significant correlations were identified between age ( p = 0.001), ESR ( p = 0.045), and failure of medical treatment. TOA diameter ( p = 0.065) showed a borderline association with surgical intervention. The risk group was defined as the combination of factors producing a risk score > 2. The area under the curve (AUC) for the risk group (age >34.3 years, ESR > 45 mm/h, and TOA size > 5.9 cm) was 0.844. The sensitivity, specificity, accuracy, PPV, and NPV were 93.8%, 75%, 83.3%, 75%, and 93.8%, respectively. Conclusions: The risk of needing surgical intervention in TOA patients can be predicted using ESR in addition to age and TOA size as risk factors.

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The value of ultrasonographic tubo‐ovarian abscess morphology in predicting whether patients will require surgical treatment

Abstract: Although increased TOA size, fever at admission, and parity were associated with increased odds of patients with TOA requiring surgical treatment, ultrasonographic TOA morphology was not.

Cited by 43 publications

References 14 publications

Sepsis Secondary toBacteroides FragilisTubo-Ovarian Abscess Requiring Hysterectomy and Bilateral Salpingo-Oophorectomy

Sepsis Secondary toBacteroides FragilisTubo-Ovarian Abscess Requiring Hysterectomy and Bilateral Salpingo-Oophorectomy

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

The prediction of surgical intervention in patients with tubo-ovarian abscess

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