Study Objective

We investigated risk factors and common causes of tubo-ovarian abscess (TOA) in non−sexually active females in order to aid in earlier diagnosis, treatment, and improved outcomes.

Design

This is a retrospective observational case series of all non−sexually active females younger than age 25 years who were diagnosed with TOA. Review of the existing literature was also performed.

Setting

Academic tertiary care children's hospital.

Participants

Ten patients meeting study inclusion criteria were identified for the study, and 33 other patients were identified in the literature.

Results

Average age at time of diagnosis was 14 years. Average body mass index was 24 kg/m². Most presented with abdominal pain, often associated with fevers, nausea, vomiting, and diarrhea. Seven of 10 patients were treated surgically with pelvic washout (4 primarily and 3 after failing empiric antibiotic therapy). Most frequently, anaerobic gut flora were isolated on culture. All patients received broad-spectrum intravenous antibiotics, and were then discharged on a course of doxycycline and metronidazole or clindamycin. Three patients required additional admissions and multiple rounds of antibiotics due to persistent symptoms. The average length of stay was 3 days for patients treated with antibiotics only and 6 days for patients requiring surgical intervention. Six patients had complete resolution of symptoms and improvement on ultrasound within 2-4 weeks. The remainder were lost to follow-up.

Conclusion

These cases, in conjunction with previous case reports, emphasize the importance of considering TOA in patients with concerning imaging or examination findings despite lack of sexual activity. Given the large proportion of cases attributable to anaerobic gut flora, treatment with antibiotics with adequate anaerobic coverage is recommended. Surgical drainage is not always necessary, but is often needed for diagnostic purposes or in patients not clinically improving with conservative measures.

中文翻译：

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非性活跃少女的卵巢卵巢脓肿：病例系列及文献综述

研究目的

我们调查了非性活跃女性中的输卵管卵巢脓肿（TOA）的危险因素和常见原因，以帮助早期诊断，治疗和改善结局。

设计

这是对所有被诊断患有TOA的25岁以下的非性活跃女性的回顾性观察病例系列。还对现有文献进行了回顾。

环境

学术三级护理儿童医院。

参加者

为该研究确定了10例符合研究纳入标准的患者，并在文献中确定了33例其他患者。

结果

诊断时的平均年龄为14岁。平均体重指数为24 kg / m ²。多数伴有腹痛，通常伴有发烧，恶心，呕吐和腹泻。10例患者中有7例接受了盆腔冲洗手术治疗（主要是4例，经验性抗生素治疗失败后3例）。最常见的是，在培养中分离出厌氧肠道菌群。所有患者均接受了广谱静脉注射抗生素治疗，然后接受了强力霉素，甲硝唑或克林霉素治疗。由于持续的症状，三名患者需要额外的入院和多轮抗生素治疗。仅使用抗生素治疗的患者的平均住院时间为3天，而需要手术干预的患者的平均住院时间为6天。6例患者的症状在2-4周内得到了完全缓解，超声检查得到了改善。其余人员则失去了后续行动。

结论

这些病例与以前的病例报告一起强调了尽管缺乏性活动但考虑到影像学或检查结果的患者考虑TOA的重要性。由于厌氧菌群可归因于大部分病例，因此建议使用具有足够厌氧菌覆盖率的抗生素进行治疗。手术引流并非总是必要的，但通常出于诊断目的或在未采取保守措施改善临床症状的患者中经常需要。