Tubo-ovarian abscess is a purulent infectious and inflammatory disease of the uterine appendages, occurring in an acute form, in which their melting with the presence of encysted formation is observed. This pathology is manifested by unilateral acute pain in the lower abdomen, vomiting, nausea, dysuric disorders, hyperthermia. For diagnosis, a vaginal examination, CT scan of the small pelvis, transvaginal ultrasound, and a variety of laboratory techniques are used. Drug therapy schemes involve the appointment of antibacterial agents, NSAIDs, infusion therapy, immunomodulators. In case of severe course and ineffectiveness of conservative treatment, the abscess is surgically removed.
Description of pathology
Tubo-ovarian abscess is one of the extremely severe forms of gynecological inflammatory processes. In the structure of infectious diseases of the pelvic organs in women, its share, according tovarious sources, reaches 6-17%. Pathology is detected mainly in young girls under the age of 20 with a low social and economic status, which is most likely due to their increased sexual activity. Erased types of inflammation often occur: in almost a third of patients, an acute clinical picture occurs against the background of a chronically occurring destructive-inflammatory process.
Causes of occurrence
Formation of volumetric purulent-inflammatory formations in the area of the uterine appendages often becomes possible with the 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:
- Presence of associative aggressive flora. In a laboratory culture from the focus of an abscess, there are, as a rule, several varieties of pathological microorganisms. In 25-45% of patients, gonococci are determined, in 25-35% - trichomonas, in 25-55% aerobic and anaerobic associations of bacteroids, gardnerella, streptococci, peptostreptococci, mobiluncus, 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, and an adhesive process in a complicated form of a chronic nature. The presence of interorgan synechia accelerates andfacilitates the formation of pyogenic membranes that limit tubo-ovarian formation from the outside.
- Immune weakening. The activation of pathogenic microflora occurs, as a rule, with a decrease in the quality of the body's defense system. The reasons for such immunosuppression may be exacerbation of extragenital and genital pathology, severe colds, frequent stress, increased physical activity, prolonged use of corticosteroids, cytostatics, acetylsalicylic acid derivatives, etc.
These causes are most often noted in the history of 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 (abortions, separate diagnostic curettage, insertion 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 by the intracanalicular (ascending) route from the vagina, cavity and cervix. In some cases, the inflammatory process is triggered by contact infection from the serous integument of the fallopian tubes. Until the final stage of tubo-ovarian purulent formation, the pathological process goes through certain stages. Initiallyin the fallopian tube, under the influence of infection, the mucosa becomes inflamed, then the inflammation begins to spread to other layers of the wall - a picture of purulent salpingitis develops in an acute form. Obliteration of the lumen of the tube, as a rule, ends with the formation of a pyosalpinx.
From the fallopian tubes, pathological microorganisms pass to the surface of the ovary and infect its tissues, which leads to the occurrence 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 "pyovar". The development of a tubo-ovarian abscess on the right or left ends with the destruction of the walls of the pyovar and pyosalpinx with the fusion of a common connective tissue pyogenic membrane. The pathological process can proceed chronically with a gradual increase in the conglomerate during the period of exacerbation, as well as sclerosis and fibrosis of tissues during periods of remission.
Symptoms of pathology
Tubo-ovarian abscess clinical symptoms usually develop acutely. A woman has severe pain in the lower abdomen, which can radiate to the lumbar region, rectum, inner thigh. The patient is also concerned about chills, fever, nausea and vomiting may occur. The temperature can be raised to 38 °C or more. At the same time, yellowish, whitish, green purulent leucorrhoea is typical, soreness in the processurination, intestinal irritation in the form of diarrhea. Due to general intoxication, weakness, mental disorders, fatigue, loss of appetite occur.
Diagnosis
Tubo-ovarian tumor is difficult to diagnose. 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 may also prescribe a number of laboratory tests, instrumental diagnostic methods are also carried out.
Tubo-ovarian abscess on ultrasound, an experienced specialist will see. 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 pelvis.
Classification of tubo-ovarian abscesses
There are several types of purulent formations:
- pyosalpinx;
- tubo-ovarian tumor;
- pyovarium.
Treatment
If a woman is suspected to have melted appendages, urgent hospitalization is indicated, bed rest is provided. With stable blood pressure and pulse, the size of the conglomerate up to 10 cm, the patient has reproductive plans, conservative therapy is recommended, which makes it possible to refuse surgical intervention in 80% of cases. Recommended for treatment of tubo-ovarian abscesses:
- Antibiotic therapy in which it is important to considerexciter sensitivity. However, this disease is usually triggered by a polymicrobial association, so a combination of cephalosporins, penicillins, semi-synthetic tetracyclines, lincosamides, etc. is prescribed.
- Anti-inflammatory non-steroidal drugs that reduce the production of thromboxane, prostaglandins and other mediators of the inflammatory process. At the same time, the drugs 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, surgery is recommended to drain the abscessive formation.
IVF for tubo-ovarian abscess of the ovary
In vitro fertilization when this pathology occurs is impossible. As a rule, before IVF, a woman undergoes a comprehensive examination by a gynecologist, and if any pathologies are found, they must be eliminated even before the IVF procedure begins. Ovarian abscess is a direct contraindication to this procedure.
