32F no PMH, p/w fever and abdominal pain x 5 days. Seen 5 days ago at OSH and treated for UTI w bactrim. Seen 2 days later, switched to doxycycline for presumed PID. GC/chlamydia negative.  Returns today w persistent pain and fever. Pain is lower, bilateral, R>L with mild distention. No urinary or vaginal symptoms. Passing gas. LMP 1 week ago, Urine preg neg 2 days ago. No prior surgeries. Unable to tolerate PO x 2 days, feels too sick to eat, has some vomiting as well.

 

Today is febrile to 100.6, hemodynamically stable, HR 80, BP 121/86, sat 99% RA, 18 RR. Abd soft, mild distented,, +BS, +bilat lower ttp, R>L with rebound and guarding, pelvic with yellow watery discharge, no CMT, +adnexal fullness. Labs notable for leukocytosis 17, lactate 1. CT abd/pelvis to r/o appendicitis, shows normal appendix but also bilateral pyosalpinx with mass effect on bladder/uterus, causing bilat hydronephrosis.  Treated w zosyn, doxycycline, 2L IVF. Pt goes to IR for drainage of bilateral TOA and does well. Cultures all negative.

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“Transvaginal ultrasound image of the left adnexa showing a tuboovarian abscess. A complex solid and cystic mass is identified in the left adnexa. The tuboovarian abscess is seen as a complex cyst (large arrow) and fluid filled tube (short arrow).” Source- uptodate

 

Tubo-ovarian Abscess

—-  Usually a complication of PID

—-  Approx 66,000 cases annually

— – Ages 15- 40

— – Microbiology: polymocrobial

— – Send testing for GC/chlam and treat PID

— – Presentation: lower abdominal pain, fever, and vaginal discharge; ruptured à acute abdomen, septic

— – Imaging: US, CT

— – Treatment: Broad spectrum IV abx, surgical drainage

— – Complication: Risk of rupture à sepsis, mortality 1.7-3.7%

 

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Reference: Uptodate