Emergency medicine residents and medical students on emergency medicine rotations.
Tubo-ovarian abscess (TOA) is a relatively common complication of pelvic inflammatory disease (PID). Recent studies have indicated approximately 4.4% of women of reproductive age will develop PID, and of those, 2.3% will go on to develop a TOA.1,2 TOA is a gynecologic emergency that requires admission to the hospital, intravenous (IV) antibiotics, and 70% of these patients will require surgical management of the infection.2 The etiology is typically polymicrobial, and broad-spectrum antibiotic coverage is recommended. Patients will often present with only pelvic pain; therefore, careful attention to their examination, lab results, and serial evaluationsmay help elicit the diagnosis. Ultrasound is the diagnostic method of choice for these patients, though computed tomography (CT) imaging and magnetic resonance imaging (MRI) have good sensitivity and specificity, with MRI approaching 89% sensitivity and 95% specificity. Patients who are diagnosed and treated expeditiously often have good resolution of their abscess. Despite this, they have increased likelihood of ectopic pregnancy, infertility, and chronic pelvic pain.
At the end of this oral boards session, examinees will: 1) Demonstrate ability to obtain a complete medical history including a detailed sexual history. 2) Demonstrate ability to perform a detailed abdominal and pelvic examination in a female patient presenting with right lower quadrant abdominal pain. 3) Investigate the broad differential diagnoses which include acute appendicitis, colitis, ectopic pregnancy, ovarian torsion, pyelonephritis, ruptured ovarian cyst, pelvic inflammatory disease and acute tubo-ovarian abscess. 4) List the appropriate laboratory and imaging studies to differentiate TOA from other diagnoses (complete blood count [CBC]; complete metabolic panel [CMP]; pregnancy test; CT scan and/or pelvic ultrasonography). 5) Identify a septic patient and manage appropriately: obtain sepsis markers such as lactic acid, provide early treatment for sepsis including obtaining blood cultures, administer adequate IV hydration and appropriate antibiotics. 6) Provide appropriate disposition to the hospital after consulting with gynecology
Oral boards case.
Tubo-ovarian abscess, pelvic pain, abdominal pain, pelvic infections, gynecologic emergencies, sexually transmitted infections.