Tubo-Ovarian Abscess

Definition - What does Tubo-Ovarian Abscess mean?

A tubo-ovarian abscess (TOA) is a collection of pus in the fallopian tubes and ovaries that generally develops as a complication of pelvic inflammatory disease (PID). The inflammation can sometimes extend to other adjacent pelvic organs like the bowel and bladder. TOA most commonly affects women of reproductive age and is typically the result of a genital tract infection or exposure to a sexually transmitted infection (STI). TOA can cause irreversible tubal and ovarian damage, posing a threat to future fertility. If not treated, TOA is a potentially life-threatening condition as the abscess has a potential to rupture, allowing for the spread of infection throughout the body which can cause organ dysfunction and potentially even death.

FertilitySmarts explains Tubo-Ovarian Abscess

Untreated inflammation of the fallopian tubes (salpingitis) can lead to the formation of pockets of pus in the tubes and ovaries.

The risk factors for TOA are the same as that of PID:

  • Unprotected sexual intercourse
  • Egg retrieval for IVF and embryo transfer: A few cases have been reported, possibly due to reactivation of a previous, but dormant PID

Women with a TOA can experience the following signs and symptoms:

  • Acute pelvic pain or severe lower abdominal pain (mostly confined to the site with infected ovaries and tubes): This can be extremely severe if the abscess has ruptured
  • Fever with chills
  • Vaginal discharge or bleeding
  • Obstruction of the urinary flow
  • Irreversible tubal and ovarian damage, posing a threat to fertility
  • The abscess can burst open leading to release of the infection into the peritoneal cavity (peritoneum is the membrane that lines the abdominal cavity), sepsis, shock, and even death in untreated cases

When a woman presents with signs and symptoms suggestive of a tubo-ovarian abscess, the doctor performs a physical exam and a pelvic or transvaginal ultrasound. Laparoscopy may be needed to more accurately define the pockets of pus in the ovaries and tubes and assist in drainage.

TOA is usually treated in a hospital setting. Small abscesses of less than 9 cm in diameter are treated by intensive antibiotic therapy whereas larger abscesses require drainage under an ultrasound or laparoscopic guidance. In more advanced cases, surgical removal of the affected ovary and fallopian tubes becomes necessary, which itself has a negative impact on fertility.

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