Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases Tuboovarian Abscess Treatment

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Bora Çoşkun
Coşkun Şimşir

Abstract

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.

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How to Cite
ÇoşkunB., & ŞimşirC. (2019). Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases. Medical Science and Discovery, 6(10), 235-240. https://doi.org/10.36472/msd.v6i10.309
Section
Research Article

References

1. Inal ZO, Inal HA, Gorkem U. Experience of Tubo-ovarian abscess: a retrospective clinical analysis of 318 patients in a single tertiary Center in Middle Turkey. Surgical infections. 2018;19(1):54-60.

2. Tokmak A, Esercan A, Sarikaya E. An incidental finding of chronic salpingitis complications: Tubo-uterine fistula. Journal of experimental therapeutics & oncology. 2015;11(2).

3. Rosado F. Factors Associated with Chlamydia trachomatis Reinfection Among Puerto Rican Adolescents 2008-2012. 2014.

4. Lachiewicz MP, Nair N. Simple Technique for Transvaginal Aspiration of a Tubo-Ovarian Abscess. Gynecologic and obstetric investigation. 2016;81(4):381-4.

5. Chu L, Ma H, Liang J, Li L, Shen A, Wang J, et al. Effectiveness and adverse events of early laparoscopic therapy versus conservative treatment for Tubo-ovarian or pelvic abscess: a single-center retrospective cohort study. Gynecologic and obstetric investigation. 2019:1-9.
6. Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best practice & research Clinical obstetrics & gynaecology. 2009;23(5):667-78.

7. Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infectious disease clinics of North America. 2008;22(4):693-708.

8. Yavuzcan A, Çağlar M, Dilbaz S, Kumru S, Avcıoğlu F, Üstün Y. Identification of Clostridium septicum in a tubo-ovarian abscess: a rare case and review of the literature. Vojnosanitetski pregled. 2014;71(9):884-8.

9. Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clinical obstetrics and gynecology. 2012;55(4):893-903.

10. Scharbo-DeHaan M, Anderson DG. The CDC 2002 guidelines for the treatment of sexually transmitted diseases: implications for women’s health care. Journal of midwifery & women's health. 2003;48(2):96-104.

11. Workowski KA. Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clinical Infectious Diseases. 2015;61(suppl_8):S759-S62.

12. Soper DE. Pelvic inflammatory disease. Obstetrics & Gynecology. 2010;116(2):419-28.

13. Kim HY, Yang JI, Moon C. Comparison of severe pelvic inflammatory disease, pyosalpinx and tubo‐ovarian abscess. Journal of Obstetrics and Gynaecology Research. 2015;41(5):742-6.

14. Mirhashemi R, Schoell WM, Estape R, Angioli R, Averette HE. Trends in the management of pelvic abscesses. Journal of the American College of Surgeons. 1999;188(5):567-72.

15. Reed SD, Landers DV, Sweet RL. Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum β-lactam agents versus clindamycin-containing regimens. American journal of obstetrics and gynecology. 1991;164(6):1556-62.

16. McNeeley SG, Hendrix SL, Mazzoni MM, Kmak DC, Ransom SB. Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess. American journal of obstetrics and gynecology. 1998;178(6):1272-8.

17. Güngördük K, Guzel E, Asicioğlu O, Yildirim G, Ataser G, Ark C, et al. Experience of tubo-ovarian abscess in western Turkey. International Journal of Gynecology & Obstetrics. 2014;124(1):45-50.

18. DeWitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalization & complications? Obstetrics and gynecology international. 2010;2010.

19. Mizushima T, Yoshida H, Ohi Y, Ishikawa M, Hirahara F. Evaluating the risk factors for developing resistance to parenteral therapy for tubo‐ovarian abscess: A case–control study. Journal of Obstetrics and Gynaecology Research. 2013;39(5):1019-23.