updated approach for TOA management

1. Tubo-ovarian abscess
Diagnosis & Management
Dr/ wael Naeem M.
Assistant lecturer
Benha university hospitals

3. Our objectives
• Importance of the topic
• Definition
• Risk factors
• Diagnosis
• DD
• Management
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4. Historical back ground
• Mortality was 50 %
• Current mortality 1.7 – 3.7 (1960).
• NOW ……..????..
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5. A tubo-ovarian abscess (TOA)
• A tubo-ovarian abscess (TOA) is an
inflammatory mass involving the fallopian
tube, ovary and, occasionally, other adjacent
pelvic organs (eg, bowel, bladder). This may
manifest as a tubo-ovarian complex (an
agglutination of those structures) or a
collection of pus .
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6. Risk factors :
• Young age 15-25 years old.
• Multiple sexual partners .
• instrumentations of the uterus .
• IVF oocyte retrieval .
• IUD insertion .
• Previous history of PID .
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7. Etiology
• POLY MICROBIAL ….?????
• Routes of infections :
• 1-
• 2-
• 3-
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8. Clinical presentations
• Classic
• Atypical form :
• 40 %.
• 25 %.
• 23%.
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9. DD
• Ectopic .
• Ovarian cyst torsion , rupture, hemorrhage .
• Degenerated fibroid .
• Pyelonephritis .
• Appendicitis , Diverticulitis .
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10. Imaging
• U-S …
• C .T ….
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11. Ultrasound
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12. C T
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13. Treatment
• Antibiotic .
• Imaging guided drainage .
• Surgical intervention .
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14. Antibiotic
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20. Special situations
• A case with IUD ..
• A case with sepsis …
• Post menopausal …
• HIV case …
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21. Take home message
• TOA is continuum of PID .
• Diagnosed clinically with either U-S or CT
assistance .
• Treated mainly medically (70% success ).
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