Transvaginal drainage of tubo-ovarian abscess under ultrasonography

Objective

In our study, we aimed to represent a case with successful endovaginal drainage of a tubo-ovarian abscess under ultrasonography which failed to recover by intravenous antibiotic treatment.

Case 

Our case was 45-year-old G6P5 premenopausal patient. The patient using intrauterine device for 7 years had abdominal pain and high fever for a week. In the ultrasonography of the patient who referred to the emergency service with acute abdominal complaint, it was observed that there were conglomerated masses consistent with tubo-ovarian abscess in sizes of 105x97 mm in the right side of pelvis and of 76x62 mm on the left side, and free fluid 50 mm deep in the Douglas cavity. WBC was 23,000 and CRP was 16.8 in the patient together with 38.5 °C body temperature. The abdomen was sensitive and there were rebound and defense. It was observed in the vaginal examination that posterior fornix was filled and revealed fluctuation. Collum movements were painful. The patient was administered 2x1 metronidazole 1 g and 2x IV ceftriaxone 1 g for 5 days. Under ultrasonography, endovaginal drainage was applied to the patient whose WBC and CRP values did not decrease, and about 700 cc purulent fluid was discharged. After the drainage, drain was inserted into Douglas. When pelvic masses were decreased after drainage, the drain was removed from the patient after her WBC and CRP values decreased and she was discharged one week later.

Conclusion 

Transvaginal discharge of pelvic abscess under ultrasonography is a safe and effective procedure. It can be used as an alternative treatment option in patients with failed intravenous antibiotic treatment.

Keywords

Tubo-ovarian abscess, ultrasonography.