A tubo-ovarian abscess is a purulent infectious and inflammatory disease of the uterine appendages, proceeding in an acute form, in which their melting is observed with the presence of a lumped formation. This pathology manifests itself as a unilateral acute pain syndrome in the lower abdomen, vomiting, nausea, dysuric disorders, hyperthermia disorders. For diagnosis, a vaginal examination, CT of the pelvis, transvaginal ultrasound, a variety of laboratory methods are used. Drug therapy regimens suggest the appointment of antibacterial agents, NSAIDs, infusion therapy, immunomodulators. In the case of severe course and ineffective conservative treatment, the abscess is removed surgically.
Pathology Description
Tubo-ovarian abscess is one of the most severe forms of gynecological inflammatory processes. In the structure of infectious diseases of the pelvic organs in women, its share, according to data from various sources, reaches 6-17%. Pathology is detected mainly in young girls under the age of 20 years with a reduced social and economic status, which is most likely due to their increased sexual activity. Erased types of inflammation often occur: almost a third of patients have an acute clinical picture against the background of a chronic destructive-inflammatory process.
Causes of occurrence
The formation of volumetric purulent-inflammatory formations in the area of ββthe uterine appendages often becomes possible with a combination of several factors at the same time and is a complication of existing gynecological pathologies. Initial tubo-ovarian abscesses are extremely rare. According to clinicians, the occurrence of this disease requires a combination of the following conditions:
- The presence of associative aggressive flora. In laboratory culture from the focus of the abscess, there are, as a rule, several varieties of pathological microorganisms. In 25-45% of patients gonococci are determined, in 25-35% - trichomonads, in 25-55% aerobic and anaerobic associations of bacteroids, gardnerells, streptococci, peptostreptococci, mobilunci, enterobacteria and other opportunistic agents.
- Adhesions in the pelvic cavity. Suppuration of the appendages is most often detected in patients with long-term salpingitis, adnexitis, oophoritis, external genital endometriosis, an adhesive process in a complicated form of a chronic nature. The presence of interorgan synechia accelerates and simplifies the formation of pyogenic membranes that limit the tubo-ovarian formation from the outside.
- Weakened immunity. Activation of pathogenic microflora occurs, as a rule, with a decrease in the quality of the protective system of the body. The causes of this immunosuppression may be exacerbation of extragenital and genital pathologies, severe colds, frequent stresses, increased physical activity, prolonged use of corticosteroids, cytostatics, acetylsalicylic acid derivatives, etc.
These causes are most often noted in the medical history of a tubo-ovarian abscess.
The likelihood of pathology is highest in patients who often change sexual partners, or those who have had bacterial vaginosis or sexually transmitted diseases. The risk of a pathological process increases after intrauterine manipulations (abortion, separate diagnostic curettage, installation of a spiral, in vitro fertilization, hysterosalpingography, removal of endometrial polyps, etc.).
Pathogenesis
The penetration of infectious agents into the region of the appendages usually occurs via the intracanalicular (ascending) route from the vagina, cavity and cervix. In some cases, the inflammatory process is triggered due to contact infection from the serous integument of the fallopian tubes. Before the final stage of tubo-ovarian purulent formation, the pathological process goes through certain stages. Initially, the mucous membrane becomes inflamed in the fallopian tube under the influence of infection, then the inflammation begins to spread to other layers of the wall - a picture of purulent salpingitis in acute form develops. Obliteration of the lumen of the tube, as a rule, ends with the formation of the pyosalpinx.
From the fallopian tubes, pathological microorganisms pass to the surface of the ovary and infect its tissues, which leads to the appearance of purulent acute oophoritis with the formation of multiple cavities filled with pus, the walls of which are represented by connective tissue and granulations. Due to the fusion of abscesses, a saccular formation is formed, which is called "piovar". The development of a tubo-ovarian abscess on the right or on the left ends with the destruction of the walls of the pyovar and pyosalpinx with the fusion of the common connective tissue pyogenic membrane. The pathological process can proceed chronically with a gradual increase in conglomerate during the period of exacerbation, as well as sclerosis and tissue fibrosis during periods of remission.
Symptoms of pathology
Clinical symptoms of a tubo-ovarian abscess usually develop acutely. A woman has severe pain in the lower abdomen, which can radiate to the lower back, rectum, inner thigh. The patient is also concerned about chills, fever, nausea and vomiting. The temperature can be raised to 38 Β° C or more. At the same time, yellowish, whitish, green purulent whites are typical, pain during urination, irritation of the intestine in the form of diarrhea. Due to general intoxication, weakness, mental disorders, fatigue, loss of appetite occur.
Diagnostics
Diagnosing the presence of a tubo-ovarian tumor is difficult. This happens due to a significant number of lesions and clinical signs. First of all, the anamnesis is studied and an examination is carried out. In order to establish an accurate diagnosis, a specialist can also prescribe a number of laboratory tests, instrumental diagnostic methods are also being implemented.
An experienced specialist will see a tubo-ovarian abscess on an ultrasound. As a result of the examination, it becomes clear that there is no differentiation between the appendage and the fallopian tube. It is also possible to determine the cystic structure of the neoplasm with the absence of clear contours and fluid in the small pelvis.
Classification of tubo-ovarian abscesses
There are several varieties of purulent formations:
- pyosalpinx;
- tubo-ovarian tumor;
- the pyovarian.
Treatment
If you suspect a meltdown of the appendages, the woman is shown urgent hospitalization, ensuring bed rest. With stable indicators of pressure and pulse, conglomerate sizes up to 10 cm, the patient has reproductive plans, conservative therapy is recommended, which allows in 80% of cases to abandon surgery. For the treatment of tubo-ovarian abscesses, it is recommended:
- Antibiotic therapy, in which it is important to consider the sensitivity of the pathogen. However, this disease is usually provoked by a polymicrobial association, therefore, a combination of cephalosporins, penicillins, semisynthetic tetracyclines, lincosamides, etc. is prescribed.
- Non-steroidal anti-inflammatory drugs that reduce the production of thromboxane, prostaglandins and other inflammatory mediators. At the same time, medications have an analgesic effect.
- Taking into account the clinical symptoms and to eliminate the complications of the main therapy, other symptomatic and pathogenetic agents are also used - immunomodulators, eubiotics, diuretics, vitamins, infusion solutions, sedatives. In the absence of the effectiveness of antibiotic therapy within 48-72 hours, surgical intervention is recommended for drainage of an abscessive formation.
IVF with ovarian abscess
In vitro fertilization with the occurrence of this pathology is impossible. As a rule, before an IVF, a woman undergoes a comprehensive examination by a gynecologist, and if any pathologies are found, they must be eliminated before the IVF procedure begins. An ovarian abscess is a direct contraindication to this procedure.