Tubo-ovarian abscess: case series and management

Abstract

Tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease, characterized by purulent collections in the fallopian tubes and/or ovaries. It primarily affects women of reproductive age and can lead to infertility, ectopic pregnancy, or chronic pelvic pain if not promptly managed. Although broad-spectrum antibiotics are the first-line therapy, many cases require surgical or radiologic intervention. We report three women aged 32–48 years with TOA, each presenting with distinct clinical features. All initially received intravenous antibiotics, but surgical management was necessary in all cases: laparoscopic drainage in one patient, laparoscopic drainage with ureteric stenting in a second, and salpingo-oophorectomy followed by image-guided drainage in the third. Microbiological analysis identified Escherichia coli in the first case and Streptococcus constellatus in the third. The second patient developed severe complications, including iliopsoas myositis and ureteric obstruction. These cases highlight the variable presentation of TOA and the potential for complications despite antibiotic therapy alone. Early recognition, multidisciplinary collaboration, and timely escalation to surgical or radiologic intervention are critical to optimize patient outcomes.