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Am J Emerg Med 2022 Jul 27;57:70-75. Epub 2022 Apr 27.

SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA. Electronic address:

Introduction: Tubo-ovarian abscess (TOA) is a rare but serious condition that carries with it a high rate of morbidity and even mortality.

Objective: This review highlights the pearls and pitfalls of TOA, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence.

Discussion: TOA is associated with pelvic inflammatory disease (PID) as well as intrauterine devices, uterine procedures, multiple sexual partners, diabetes mellitus, and immunocompromised states. Read More

Am J Obstet Gynecol MFM 2022 07 8;4(4):100643. Epub 2022 Apr 8.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Dr Berghella). Electronic address:

Background: Pelvic inflammatory disease during pregnancy is a rare and an understudied occurrence with potential negative outcomes.

Objective: This study aimed to evaluate the outcomes of pregnant women with pelvic inflammatory disease with or without pelvic abscesses.

Data Sources: We performed a systematic review of the literature using Ovid MEDLINE, Scopus, CINAHL, and PubMed (including Cochrane) with no time limitations. Read More

Fukushima J Med Sci 2022 Apr 19;68(1):57-61. Epub 2022 Mar 19.

Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital.

A tubo-ovarian abscess is an infection that occurs as a sequela of pelvic inflammatory disease. There is no reported association between a tubo-ovarian abscess and cri du chat syndrome in the medical literature. Herein, we report the case of a 44-year-old woman with cri du chat syndrome who was subsequently diagnosed with a tubo-ovarian abscess. Read More

Gynecol Minim Invasive Ther 2022 Jan-Mar;11(1):61-63. Epub 2022 Feb 14.

Department of Gynecologic Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan.

Ovarian abscess is thought to be caused by ascending infection. We experienced a case with ovarian abscess caused by Salmonella. The patient had been monitored for endometrial cysts at an outpatient clinic. Read More

Cureus 2021 Nov 30;13(11):e20052. Epub 2021 Nov 30.

Obstetrics and Gynecology, Bethesda Hospital East, Boynton Beach, USA.

Pelvic inflammatory disease (PID) and tubo-ovarian abscess (TOA) are serious diagnoses to consider in reproductive-age women presenting with abdominal or pelvic pain. Management can be medical or surgical depending on severity. This case report outlines the unique presentation of TOA in a 15-year-old female presenting with acute abdominal pain with a recent past surgical history of appendectomy. Read More

Ann Med Surg (Lond) 2021 Dec 10;72:103049. Epub 2021 Nov 10.

Student of Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction And Importance: Tubo-ovarian abscesses (TOA) is presented with multiple clinical manifestations including gastrointestinal findings.

Case Presentation: Herein, we present a case of complicated diverticulitis that was misdiagnosed as TOA, owing to overlapping genital involvement.

Clinical Discussion: Imaging could be misleading in these patients as a result of severe inflammation of intestines and surrounding organs. Read More

Gynecol Obstet Fertil Senol 2022 Mar 17;50(3):272-275. Epub 2021 Nov 17.

Department of gynecology obstetrics and reproductive medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address:

Int J Gynaecol Obstet 2022 Jun 12;157(3):588-597. Epub 2021 Oct 12.

Department of Obstetrics & Gynaecology, West Middlesex University Hospital, Middlesex, UK.

Objective: To create a risk scoring system comprised of clinical and radiological characteristics that can predict the likelihood of antibiotic treatment failure of tubo-ovarian abscesses. The score should guide clinicians in identifying patients to whom early intervention should be offered instead of a prolonged trial of antibiotics.

Methods: A multicenter, retrospective cohort study carried out between January 1, 2013 and September 30, 2019, identified consecutive patients with tubo-ovarian abscess. Read More

ANZ J Surg 2021 07;91(7-8):1635-1636

Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.

Case Rep Womens Health 2021 Jul 10;31:e00335. Epub 2021 Jun 10.

Obstetrics and Gynecology Department, Consorci Parc de Salut MAR, Universitat Autònoma de Barcelona, Barcelona, Passeig marítim 25-29 (08003), Spain.

Pelvic inflammatory disease after hysterectomy is rare and the underlying route of infection is highly heterogeneous. We report the case of a 52-year-old woman with a history of vaginal hysterectomy for uterine prolapse admitted to the emergency department with acute abdominal pain and fever. Vaginal discharge and pelvic tenderness were evident in the clinical examination. Read More

J Obstet Gynaecol Res 2021 Mar 31;47(3):1199-1203. Epub 2021 Jan 31.

Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, South Korea.

We present the case of a 26-year-old multiparous woman who experienced rupture of a tubo-ovarian abscess during the second trimester of pregnancy. She presented with epigastric and right lower quadrant pain at 12 + 0 weeks' gestation. There were no other specific findings on the magnetic resonance imaging images. Read More

MedEdPORTAL 2021 01 25;17:11080. Epub 2021 Jan 25.

Assistant Professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth.

Introduction: Reproductive-age female patients commonly seek evaluation for pelvic pain in a variety of health care settings. Thus, teaching medical students how to effectively evaluate female pelvic pain is a necessary part of medical education. There are limited opportunities, however, to reinforce the needed skills for this common but sensitive presentation that can be anxiety-producing for preclinical students. Read More

Eur J Obstet Gynecol Reprod Biol 2021 Mar 15;258:253-257. Epub 2021 Jan 15.

Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey.

Introduction: We aimed to identify factors that would predict the success of antibiotic treatment and the need for surgical treatment in tubo-ovarian abscess (TOA) patients.

Materials And Methods: The data of 146 patients with a diagnosis of TOA were analyzed retrospectively. Patients were separated into two groups; successfully treated with antibiotics and going under surgery after antibiotic treatment failure. Read More

Acta Med Litu 2021 22;28(2):360-366. Epub 2021 Dec 22.

Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.

Background: Endometriosis is defined as a chronic, inflammatory, estrogen-dependent gynaecologic disease. It affects approximately 5-10% of reproductive-age women worldwide. Ovarian endometriosis is the most frequent form of this condition. Read More

Cureus 2020 Nov 23;12(11):e11647. Epub 2020 Nov 23.

Emergency Medicine, Mayo Clinic, Jacksonville, USA.

Introduction Pelvic inflammatory disease (PID) is a spectrum of illness ranging from mild illness to more severe forms including tubo-ovarian abscess, hydrosalpinx, pyosalpinx, oophoritis (THPO). The objective of the study was to report rates and clinical characteristics of females presenting to the ED with a diagnosis of THPO in relationship to the presence or absence of sexually transmitted infections (STIs). Methods A database of ED patient encounters occurring from April 18, 2014, to March 7, 2017 was created. Read More

J Pediatr Adolesc Gynecol 2021 Jun 16;34(3):328-333. Epub 2020 Dec 16.

Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.

Study Objective: We investigated risk factors and common causes of tubo-ovarian abscess (TOA) in non-sexually active females in order to aid in earlier diagnosis, treatment, and improved outcomes.

Design: This is a retrospective observational case series of all non-sexually active females younger than age 25 years who were diagnosed with TOA. Review of the existing literature was also performed. Read More

Anaerobe 2021 Feb 30;67:102312. Epub 2020 Nov 30.

Monash Infectious Diseases, Monash Health, Clayton Rd, Clayton, Vic, 3168, Australia; School of Clinical Sciences, Monash University, Clayton Rd, Clayton, Vic, 3168, Australia.

Ruminococcus gnavus is a Gram-positive anaerobe and normal gut commensal in the human host. There have been a small number of reported cases of infections attributed to R. gnavus, and no cases of urogenital infections have previously been published. Read More

J Obstet Gynaecol 2021 Oct 28;41(7):1097-1101. Epub 2020 Nov 28.

Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.

This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Read More

Pediatr Rev 2020 Oct;41(10):522-537

Division of Adolescent and Young Adult Medicine and.

Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Read More

J Minim Invasive Gynecol 2021 05 4;28(5):1060-1065. Epub 2020 Sep 4.

Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors).

Study Objective: To compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID).

Design: We performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery. Read More

J Community Hosp Intern Med Perspect 2020 Mar 3;10(2):162-165. Epub 2020 Mar 3.

Internal Medicine Residency Program, Memorial Healthcare System, Hollywood, FL, USA.

 is a gram-positive bacillus in the female genital tract believed to be a commensal organism that inhibits the growth of more virulent pathogens.  is a gram-negative bacillus species also typically commensal in the female genital tract. as the primary causative agent in perinephric abscesses and bacteremia has been documented, albeit very uncommon and opportunistic. Read More

Ther Umsch 2020 ;77(4):164-170

Universitätsklinik für Frauenheilkunde, Inselspital Bern.

Management of Pelvic Inflammatory Disease Pelvic inflammatory disease (PID) is a common medical problem, but the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. As PID might cause late complications such as infertility or chronic pelvic pain, it is of prime importance that the diagnosis of PID is made promptly to assure the early onset of an adequate antibiotic therapy. Where uncomplicated PID usually has a favorable course, complicated forms with tubo-ovarian abscess generally require surgical exploration. Read More

ANZ J Surg 2021 01 12;91(1-2):204-205. Epub 2020 Jun 12.

Department of Surgery, Joetsu General Hospital, Joetsu City, Japan.

J Gynecol Obstet Hum Reprod 2021 Mar 17;50(3):101811. Epub 2020 May 17.

Department of Obstetrics & Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, IRCCS Sacro Cuore Don Calabria Hospital - Negrar (Verona), Italy, International School of Surgical Anatomy, Italy.

Objective: To study possible associations between endometriosis and pelvic inflammatory disease (PID).

Design: Retrospective cohort analysis over 14 consecutive years, based on medical records and insurance coding in a tertiary care endometriosis reference center.

Setting: Tertiary care reference center for endometriosis. Read More

J Gynecol Obstet Hum Reprod 2020 Nov 13;49(9):101789. Epub 2020 May 13.

Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.

Purpose: To evaluate and better characterize the incidence, clinical presentations and risk factors of TOA in postmenopausal women and to evaluate the incidence of underlying malignancy in postmenopausal women with TOA.

Methods: Electronic based search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials. The following medical subject heading (Mesh) terms, keywords, and their combinations were used: "tubo-ovarian abscess, pelvic inflammatory disease, menopausal and postmenopausal". Read More

Case Rep Womens Health 2020 Apr 24;26:e00192. Epub 2020 Mar 24.

Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia.

Haematogenous or direct spread of bacterial infection causing pelvic inflammatory disease of the upper female reproductive tract is uncommon. We report a diagnostically challenging case of a 41-year-old woman with a background of Stage 4 endometriosis presenting with fever, diarrhoea and abdominal pain with recent history of pyelonephritis. Initially managed for undifferentiated abdominal pain with unclear focus of infection, a broad range of investigations were undertaken. Read More

J Obstet Gynaecol 2021 Jan 9;41(1):118-123. Epub 2020 Mar 9.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) has been debated. We aimed to evaluate the differences between IUD users and non-users among women hospitalised with a diagnosis of PID. Our hypothesis was that the role of a present IUD among PID patients is minimal, if any. Read More

J Gynecol Obstet Hum Reprod 2020 May 20;49(5):101714. Epub 2020 Feb 20.

Société de Pathologie Infectieuse de Langue Française (SPILF), 21 rue Beaurepaire, 75010 Paris, France.

Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). Read More

Case Rep Womens Health 2020 Apr 8;26:e00181. Epub 2020 Feb 8.

Department of Obstetrics and Gynecology, Blacktown Hospital, NSW, Australia.

Pneumoperitoneum seen on an X-ray or computed tomography (CT) image points to a diagnosis of ruptured viscus and immediate surgery is warranted. A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. Very few cases have been reported where the pneumoperitoneum is caused by an abscess involving the adnexa. Read More

ANZ J Surg 2020 10 20;90(10):2092-2093. Epub 2020 Feb 20.

Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia.