title: Image-guided drainage of tuboovarian abscesses of gastrointestinal or genitourinary origin: a retrospective analysis.
abstract: OBJECTIVE
  To analyze the authors' success with image-guided drainage of tuboovarian abscesses (TOAs).
  
  
  METHODS
  Retrospective analysis of patients with image-guided TOA drainage from 1999 to 2008 was performed. Patient recovery without salpingo-oophorectomy was considered clinical success. A total of 57 TOAs were drained in 49 female patients (mean age, 43; range, 12 to > 89).
  
  
  RESULTS
  Thirty-three (58%) TOAs were drained percutaneously using computed tomography guidance and 24 were ultrasound guided (21 transvaginally, three transabdominally). Fifty-three TOAs were drained with catheter placement, and four were drained with aspiration alone. Abscess etiologies include pelvic inflammatory disease (n = 21, 37%), gastrointestinal conditions related (n = 21, 37%), gynecologic surgery (n = 8, 14%), and other (12%). Image-guided drainage resolved TOAs without salpingo-oophorectomy in 74% of cases overall (42 of 57) and 88% (29 of 33) of gynecologic-related cases, including 95% (20 of 21) of pelvic inflammatory disease cases. Salpingo-oophorectomy was performed more often in gastrointestinal-related cases (10 of 21, 48%) than for all other causes (five of 36, 14%; P < .001), with concurrent bowel surgery performed in the majority of the gastrointestinal-related cases. Mean follow-up after image-guided drainage was 48 months (range, 1-113) in patients who did not have related surgery. In patients who underwent salpingo-oophorectomy, it was performed on average 2.2 months (range, 0.5-5) after initial drainage. Two minor complications occurred; both involved catheter transgression of the urinary bladder in patients with transvaginal ultrasound-guided drainages. The patients were successfully treated conservatively with Foley catheter bladder decompression, without prolonged hospitalization.
  
  
  CONCLUSIONS
  TOAs, especially of gynecologic origin, can often be managed successfully with image-guided drainage. After image-guided drainage, patients with gynecologic-related TOA were less likely to undergo salpingo-oophorectomy than patients with gastrointestinal-related TOAs.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA. rlevenso@bidmc.harvard.edu
authors.forename: Robin B
authors.initials: RB
authors.lastname: Levenson
authors.forename: Kara M
authors.initials: KM
authors.lastname: Pearson
authors.forename: Anuradha
authors.initials: A
authors.lastname: Saokar
authors.forename: Susanna I
authors.initials: SI
authors.lastname: Lee
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mueller
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hahn
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001900:Boston; D002404:Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005184:Fallopian Tube Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D005260:Female; D052776:Female Urogenital Diseases / Q000150:complications*; D005767:Gastrointestinal Diseases / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D010052:Ovariectomy; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D058994:Salpingectomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents