Kara M. Pearson MS, Presenter: Nothing to Disclose

Susanna In-Sun Lee MD, PhD, Abstract Co-Author: Nothing to Disclose

Anuradha Saokar MBBS, Abstract Co-Author: Nothing to Disclose

Hemali J. Desai MD, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Nothing to Disclose

Peter F. Hahn MD, PhD, Abstract Co-Author: Nothing to Disclose

TOA's that fail conservative management with antibiotics have previously been treated surgically. We reviewed the etiologies, interventional methodology, and success rate for non-surgical drainage of TOA's under imaging guidance.

We queried hospital and radiology databases to identify all patients who underwent imaging-guided drainage of TOA's from 2000-2007. Patient history and clinical success, defined as avoidance of subsequent salpingoophorectomy, was abstracted from the electronic medical record. Imaging approach, needle and catheter manipulation, fluid yield and technical success were determined from PACS images and from radiology and bacteriology reports.

45 cases of TOA’s were drained in 44 women (mean age 46, range 16-95). 25 drainages were accomplished with CT guidance percutaneously and 20 were sonographically-guided (2 trans-abdominal, 18 trans-vaginal). In 33 cases a single catheter was left in, in 9 cases multiple catheters were used and in 3 cases simple aspiration was used. 41/45 (91%) of cases were technically successful. Etiologies included PID (31%), bowel-related (47%), OB-GYN surgery (13%) and other (9%). Bowel-related etiologies include diverticulitis, Crohn’s and appendicitis. Other causes included pyelonephritis, endometriosis and cervical cancer. Aspirates were culture positive in 86% of PID, 81% of bowel-related, 33% of OB-GYN surgical and 100% of other cases. 18% (8/45) of cases required redrainage. Imaging-guided drainage successfully avoided salpingoophorectomy in 73% of cases (33/45). Clinical success rate was lower for bowel-related TOA’s (48%, 10/21) when compared to other etiologies (96%, 23/24) (p < .001). Average time of follow-up for patients not requiring surgery was 38.4 months (range 0.4-95.0). For the others, surgery was 4.4 months (range 0.5-36.0) after image-guided drainage. No significant complications occurred.

TOA's can be treated safely and effectively with image-guided aspiration or catheter drainage, especially those of gynecologic rather than gastrointestinal etiology and should be considered as an alternative to surgery for the treatment of TOA's unresponsive to medical management.

The conventional treatment of tubo-ovarian abscesses (TOA’s) unresponsive to medical management has been salpingoophorectomy; but most TOA’s can be treated successfully with image-guided drainage.

Pearson, K, Lee, S, Saokar, A, Desai, H, Mueller, P, Hahn, P, Image-guided Drainage of Tubo-Ovarian Abscesses Refractory to Medical Therapy: Are We Successful?.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021273.html