Tubo-ovarian abscess

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PubMed Search: Tubo-ovarian abscess

Mohiedean Ghofrani, M.D.
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Cite this page: Ghofrani M. Tubo-ovarian abscess. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumortuboovarianabscess.html. Accessed May 19th, 2024.
Definition / general
  • Nonspecific abscess localized to the ovary
  • Primary ovarian abscess is defined as inflammation arising in the ovarian tissue
  • Secondary ovarian abscess originates in extraovarian sites

  • Primary ovarian abscesses are quite rare; most cases of ovarian abscess are secondary

  • Primary abscesses may arise due to disruption of ovarian capsule, as in ovulation or surgical intervention (vaginal hysterectomy, ovarian cystectomy, caesarean section, pregnancy, use of intrauterine device, transvaginal or percutaneous needle aspiration of endometrioma or follicle aspiration as part of in vitro fertilization), which gives bacteria access to the ovarian stroma (Tunis Med 2010;88:285)
  • Also occurs due to hematogenous and lymphatic spread
  • Secondary ovarian abscess may be associated with tubo-ovarian abscess, salpingitis, ascending infection of lower genital tract (pelvic inflammatory disease) or complication of GI infections (diverticulitis, appendicitis)

Clinical features
  • Nonspecific symptoms, making diagnosis difficult
  • Time between capsule disruption and clinical presentation depends on bacterial inoculum dose, type and virulence and if infection occurred secondary to direct contamination at surgery or via devitalized tissue

  • Most common infectious organisms are Streptococcus type B; other bacteria

Case reports

  • Initial treatment is intravenous antibiotics
  • If no response within 72 hours, if abscess ruptures or if surrounding organs are affected, immediate laparoscopy or laparotomy with removal of the ovary is the main treatment

Gross description
  • Large, loculated cyst with pus or secretion

Gross images

AFIP images

Tubo-ovarian abscess
complicating colonic

Ovarian abscess
associated with
Crohn's disease

Microscopic (histologic) description
  • Cyst wall often contains ovarian stroma

Microscopic (histologic) images

Contributed by Eman Abdelzaher, M.D., Ph.D. and AFIP

Tubo-ovarian actinomycosis

Ovarian stroma
is replaced by
collagenous tissue

Pelvic inflammatory disease (PID)
Definition / general
  • Polymicrobial infection in women characterized by inflammation of the upper genital tract, including endometritis, salpingitis, pelvic peritonitis and occasionally leading to tubo-ovarian abscess

  • Primarily affects young, sexually active and reproductive aged women
  • Inversely proportional to age with the highest rates in the 15 to 19 year old group
  • Incidence steadily increased in 1970s due to rising rates of STDs and peaked in early 1980s
  • Although current incidence is lower, estimates of prevalence are not exact and likely underrepresent the true prevalence of disease due to subclinical PID, increasing rates of outpatient diagnosis and inaccuracies in diagnosis

  • Usually begins in endometrium and is associated with tubal involvement and tubo-ovarian abscess or cyst

  • Most commonly due to gonorrhea, chlamydia, enteric bacteria or puerperal infections (from end of third stage of labor until uterus completely involutes at 3 - 6 weeks)
  • Acute, symptomatic forms, previously primarily due to Neisseria gonorrhoeae, have been replaced by mild to moderate cases due to Chlamydia trachomatis or mycoplasmas
  • Usually polymicrobial

Clinical features
  • No single, subjective complaint, physical examination finding or laboratory finding is highly sensitive or specific for the diagnosis
  • Pelvic pain, adnexal tenderness, fever and vaginal discharge are common
  • Classified as acute, subacute or subclinical

  • Peripheral white blood cell count is nonspecific and elevated in only 44% of cases
  • Elevations in C reactive protein or erythrocyte sedimentation rate show good sensitivity and specificity
  • Vaginal wet smear with 3+ white blood cells per high power field has a high sensitivity for upper genital tract infection and the absence of WBCs has a high negative predictive value
  • Transvaginal ultrasound may demonstrate a swollen, tortuous fallopian tube
  • Laparoscopic evaluation of the pelvic organs is considered the gold standard for diagnosing PID

Prognostic factors
  • Short and long term sequelae include tubal factor infertility, ectopic pregnancy, chronic pelvic pain, peritonitis, bacteremia or intestinal obstruction due to adhesions


Gross images

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