An estimated one in ten people with a uterus suffer from pelvic inflammatory disease (PID) during their reproductive years. Tubo-ovarian abscesses (TOA) are a late complication of PID that develop in 15 to 35% of hospitalized cases. TOAs can cause long term complications such as infertility, ectopic pregnancy, and chronic pelvic pain.

There is increasing evidence to support early surgical intervention in patients who do not demonstrate improvement after receiving conservative management. Recent studies have demonstrated lower blood loss, shorter operative time, and a four-fold higher subsequent pregnancy rate with early surgical intervention.

Gynecologists rarely operate on TOAs, which results in a lack of familiarity and expertise in this area, compounded by the technical difficulties associated with operating in the presence of pelvic infection. However, surgical intervention is necessary for approximately 25% of patients with TOA. This video reviews the role of surgery in TOA management and provides a structured surgical approach to managing complex TOAs.

Design: Case study. Patient was followed for 7 months.

Setting: OR

Patients or Participants: One patient who presented with pelvic pain and bowel obstruction resulting from multiple complex TOAs.

Interventions: This patient received conservative management for treatment of TOA, followed by surgical intervention.

Measurements and Main Results: n/a

Conclusion: n/a