Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases

Objective: The main outcome measure of the present study was to find out the predictive factors affecting the need for surgery in patients diagnosed with tuboovarian abscess (TOA). We also examined the success of different medical treatment regimens in those patients. Material and Methods: This was a retrospective clinical study performed on 96 TOA patients who were treated in the current hospital between August 2015 and August 2019. All patients underwent physical examination and ultrasonographic imaging with some laboratory tests to investigate the presence of TOA. Two different medical treatment regimens were administered as recommended by the international guidelines after the initial diagnoses. Patients with worsening clinical and/or laboratory findings and/or who did not respond to medical treatment were taken to surgery. Predictive factors for surgical intervention and success rates of medical treatment regimens were evaluated. Results: White blood cell (WBC) levels≥ 16000 and abscess size≥ 7 cm was strongly correlated with the requirement for surgery. The 94 patients received the Regimen 1. Six patients underwent surgery urgently when they were under medical treatment. Regimen 1 failed in 21 (22.34 %) patients out of 94, Regimen 2 was shifted to. Six patients (28.5%) out of 21 underwent surgery because of treatment failure with Regimen 2. Recovery was achieved in the remaining 15 (71.4%) patients. Conclusion: The success of medical TOA treatment was found to be high. Therefore, medical treatment can be applied first, except in case of acute abdomen. It was found that WBC and abscess diameter in patients with TOA in admission were the most important factors affecting the need for surgery. The factors affecting the duration of medical treatment were found to be age, WBC count, CRP (C-Reactive Protein), ESR (Erythrocyte Sedimentation Rate) and NLR (Neutrophil/Lymphocyte Ratio) levels.

Laparoscopic Resection of An Extensive Tuboovarian Abscess in A Mechanical Valve Replacement Woman

The case is a 44-year-old-female who presented with right lower abdominal pain without fever or leukocytosis. She had previous mechanical valve replacement with taking warfarin for last ten months from the diagnoses of infective endocarditis. The ultrasonography showed bilateral complex ovarian mass. At laparoscopy, the patient had a right tubo-ovarian abscess and a left mature teratoma with extensive adhesions to the rectum. A case illustrates an uncommon premenopausal age with right tuboovarian abscess and left mature teratoma. The laparoscopic surgery is an excellent benefit for quicker recovery time, smaller incisions, less post-operative pain, and especially of a few infections that will affect to underlying disease of the patient.