A Patient with Tubo-Ovarian Abscess with Endometriosis after Transvaginal Oocyte Retrieval

Ultrasound-guided oocyte retrieval is a standard procedure for ovum pick up (OPU) during in vitro?fertilization. Possible complications include tubo-ovarian abscesses (TOAs) in the fallopian tubes, and endometriosis may be associated with increasing?the severity of pelvic infection. A 35-year-old?woman who had been treated for infertility and endometriosis presented with abdominal pain that appeared several days after OPU. There were no significant changes in the size of both ovaries and fallopian tubes. A week later, transvaginal echography revealed right oviduct enlargement. Because conservative treatment with antibiotics before this revelation had not been successful, laparoscopy was performed for abscess drainage and/or excision of the adnexa. Intraoperative findings were an abscess in the right adnexa involving the ovary and fallopian tube. Preservation of the right fallopian tube was difficult due to the risk of prolonged infection, and a right appendectomy was performed. The diagnosis was a right TOA. Severe cases of pelvic infection after OPU may cause infertility. The presence of endometriosis may aggravate the infection, but the relationship between the extent of the endometriosis and the severity of the infection is not known. Even if the endometriosis is mild, as it was in this patient, surgical treatment should be considered if a severe infection occurs after OPU and conservative treatment is not effective.

Diverticulitis presenting as a tubo-ovarian abscess with subsequent colon perforation

Described here is an unusual complication of a common condition; diverticulitis resulting in a tubo-ovarian abscess. The etiology of this abscess was clinically unapparent due to atypical presenting symptoms and signs. Furthermore, radiological diagnosis was misleading because of an inflammatory reaction of the colon which prevented visualization of diverticula. Failure to correctly identify the underlying pathology early in the patient's course of treatment led to a perforation of the colon.

Therapeutic Process of Gynecological Pelvic Abscess— Retrospective Review of 20 Cases

Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to evaluate treatment efficacy. The medical records of 20 patients diagnosed with pelvic abscess and admitted to our hospital for treatment between November 2006 and December 2009 were retrospectively examined. Results: Mean age of the patients was 50 ± 16.6 years. Pelvic abscess occurred spontaneously in 13 patients and secondary to surgical manipulation in 7 patients. In the 13 patients with spontaneous abscess, 7 had undergone pelvic surgery and 2 had undergone insertion of an intrauterine contraceptive device. Concomitant endometriosis was present in 5 of the 13 (38.5%) patients. A positive bacterial culture from the abscess was obtained in 16 of 19 (84.2%) patients tested. Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients. Although multiple antibiotics were administered in all cases, 19 of the 20 (95%) patients eventually required surgical intervention, which included total hysterectomy plus adnexectomy, drainage under laparotomy or drainage alone. Anaerobic bacteria were frequently detected as the causative bacteria. Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery.

盆腔脓肿12例分析

目的探讨减少盆腔脓肿（PA）的误诊及治疗方法。方法对12例PA患者病史、诊治经过及转归进行回顾性分析。结果本组误诊率为41.7%。11例住院手术治疗,10例随访1年无下腹痛及盆腔包块现象。结论详细的病史采集（尤其是月经史,既往史）及严格的体格检查可以减少误诊。手术治疗PA具有治疗及时、疗效好、恢复快等优点。

Management of High Complicated Genital Infections at the Aristide De Le Dantec Hospital: Apropos of Six Cases

Objective: To study the epidemiology, the diagnostic elements and the prognosis after laparotomy surgery, of complicated upper genital infections. Patients and method: This is a retrospective study of six cases of complicated upper genital infections collected over a period of 20 months in the Obstetrics and Gynecology department of the Aristide Hospital Center of LEDANTEC. Results: The average age of the patients was 37.67, in two patients;a hysterosalpingography had been performed less than seven days before the start of the symptoms, a notion of multiple sexual partners was noted in two patients. All patients presented with acute abdominal-pelvic pain associated with vomiting in three patients. An infectious syndrome was found in two patients, adnexal pain caused in four patients and signs of peritoneal irritation (guarding and umbilical tenderness) in three patients. Para-clinically, a biological inflammatory syndrome was found in all patients, including an elevation of C-reactive protein in all patients and hyperleukocytosis in four patients and an elevation of CA 125 in two patients. The cytobacteriological examination of the pus taken intraoperatively was positive in two patients, the isolated germs were Pseudomonas aeruginosa and Enterobacter cloacae. Pelvic ultrasound was performed in all patients and revealed a cystic adnexal mass in five cases, a pyosalpinx and peritoneal effusion in two cases. Abdominal & pelvic computed tomography was performed in four patients and revealed a lateral-uterine adnexal mass in two cases, pyosalpinx in two cases, uretero-hydronephrosis and peritoneal effusion in one case. An exploratory laparotomy was performed in each patient and confirmed the diagnosis of tuboovarian abscess, the presence of pelvic adhesion and purulent effusion in four patients, the presence of false membranes in two patients, pyometra and isolated bilateral pyosaplinx were found in one patient. Radical surgical treatment was associated with double probabilistic antibiotic therapy and symptomatic treatment in all patients. The postoperative course was favorable in most cases;postoperative pneumopathy was noted and resolved under treatment.