Statistical analysis of tuboovarian abscess cases for 6(six) years

Aim: The aim of this study was to retrospectively evaluate the clinical and laboratory outcomes of the patients treated at our clinic due to tuboovarian abscess (TOA) and to investigate the procedures used for treatment and posttreatment complications. Materials and Methods: The retrospective analysis included 100 patients who were treated at Dicle University Medical School Department of Gynecology and Obstetrics due to tuboovarian abscess between January 2009 and April 2015. Demographic characteristics, risk factors, clinical and laboratory outcomes, treatment procedures, and posttreatment complications were recorded. Results: The ages of the patients ranged between 15-19 years and the mean age was 36.46 ± 11.6 years. Of all the patients, 73% were multiparous. Most common complaints included pelvic pain (%100), fever (%19), and vaginal discharge (%27). The prevalence of intrauterine device (IUD) use was 7% and the prevalence of pelvic inflammatory disease was %29. The prevalence of history of intrauterine or intraabdominal surgery in patients with a history of surgery was %60,5. Clinical findings of the patients were as follows: %25 of the patients had a temperature of ≥38 °C, leukocytosis was present in %70 of the patients based on a leukocyte count of >10,000 /μL and in %55 based on a leukocyte count of >12,000 /μL, %85 of the patients were present with increased sedimentation rate, and %92 of the patients had high C-reactive protein levels. No statistical significance was observed between the treatment procedures in terms of leukocyte counts (p>0.05). Medical treatment was performed in all the patients, whereas 38 underwent medical treatment only, 47 underwent surgical treatment in addition to medical treatment, and 15 underwent ultrasound USG guided drainage in addition to medical treatment. The patients who wished to preserve fertility underwent USG guided abscess drainage with laparoscopy (L/S) or laparotomy (L/T). Ten percent of the patients were at postmenopausal period and most of these patients underwent respective surgery. Of the patients who underwent surgery, 17 underwent drainage, 14 underwent salpingoooferectomy, 3 underwent salpingectomy only, 1 underwent hysterectomy +salpingectomy, 2 underwent hysterectomy+unilateral salpingoooferectomy (TAH+USO), and 10 underwent hysterectomy+bilateral salpingoooferectomy (TAH+BSO). Among the patients who underwent surgery, %6,3 of them developed intraoperative intestinal injury and primary intestinal repair was intraoperatively performed in these patients by a general surgeon. Postoperative wound site infection occurred in %8,5 of the patients. Overall mean hospital stay was 7.9 ± 6 days, whereas mean hospital stay was 6.9 ± 2.8 days in the patients who underwent medical treatment, 8.0 ± 8.03 days in the patients who underwent surgery, and 10.5 ± 3.9 days in the patients who underwent USG guided drainage. Conclusion: Tubo-ovarian abscess (TOA) remains a serious disease with high rates of morbidity and mortality and thus the ideal treatment modality should be determined based on the age and clinical condition of the patient, and desire for pregnancy. Since TOA leads to high morbidity and decreased fertility rates, a rapid diagnosis of TOA, a prompt initiation of the treatment, and switching to surgical treatment in patients not responding to medical treatment is of prime importance. In addition, USG guided drainage should be kept in mind in the patients not responding to medical treatment and rejecting surgical intervention. Key words: Tubo-ovarian Abscess (TOA), Pelvic Inflammatory Disease (PID), Medical Treatment, Surgical Treatment, USG Guided Drainage