Tubo-ovarian abscesses and the effect of transvaginal ultrasound guided drainage – a retrospective cohort study

Abstract

Objective:Tubo-ovarian abscesses (TOA) are a serious complication to pelvic inflammatory disease with long-term complications such as infertility and chronic pain. Treatment consists of intravenous antibiotics combined with laparoscopic or transvaginal ultrasound-guided drainage (TVULD), but the evidence regarding optimal treatment are scarce, and evaluation of short- and long-term effects have yielded inconsistent results. Our aim was to evaluate the effect of transvaginal ultrasound-guided drainage with antibiotic treatment on both short- and long-term outcomes for patients admitted with a tubo-ovarian abscess.   Methods:All women admitted with a TOA to our department were included from March 2017- May 2020. They were evaluated with a gynecological examination, TVUL, white blood cell count (WBC) and CRP. All received intravenous antibiotics and were evaluated for possible TVULD. All received orally administered antibiotics upon discharge, and follow-up was with a 1-3-month interval until patients were without symptoms or underwent laparoscopic surgery. Results:Forty patients were included, 30 (75%) premenopausal. Mean size of TOA were 6.3 cm (SD 2.3), and 35 (87.5%) patients received both antibiotics and drainage. Eighteen (45%) patients underwent secondary surgery following the TOA, and comparing the surgery vs. non-surgery group, we found that at admission temperature, WBC count at admission, aspirated material in ml and need of more than one drainage predicted undergoing laparoscopy following discharge. However, when performing multivariate analysis comparing the two groups regarding the abovementioned factors as well as age, admission time, antibiotic treatment time and follow-up, we did not find any statistically significant difference (p=0.072). Finally, we found that more than one drainage increased the risk of undergoing laparoscopy (OR 8, CI 1.43-44.92). Conclusion:TVULD combined with antibiotics are a safe and effective treatment for TOAs. We found a trend supporting that patients needing laparoscopy following initial TVULD present with a more severe clinical picture and that different clinical and paraclinical factors could be used as predictors for undergoing secondary laparoscopy. Finally, we saw that patients with more than one drainage, have an increased risk of requiring secondary laparoscopy. These findings and predictors need to be tested and confirmed in larger prospective studies.