Current Management of Tubo-Ovarian Abscess; Should We Drain Earlier and Smaller?

Purpose: To determine the effectiveness of current management patterns for tubo-ovarian abscess (TOA) and assess potential for improvement.

Materials and Methods: This retrospective review included all patients at a single tertiary care center who underwent initial treatment of TOA, defined by CPT code, from 11/1/2020 to 11/1/2024. 108 patients were identified; 32 were excluded for recurrent TOA or alternative diagnoses. The electronic medical record was reviewed for treatment (surgical, medical or catheter drainage,) clinical and laboratory data, clinical success, hospital length of stay, and adverse events (AE).

Results: Of 76 patients, 51 (67%) had primary conservative treatment with antibiotics; 35 were clinically successful and 16 (31%) ultimately required “salvage” catheter drainage; of these 13 (81%) were successfully treated. Salvage drainage patients had significantly larger abscesses on presentation than successful primary conservative patients (6.8 vs. 5.2 cm, p=0.009).



19 patients (25%) had primary image guided drainage; 18 (95%) clinically successful. Primary drainage patients had significantly larger abscesses (8.6 cm) than primary antibiotics patients (5.2 cm, p< 0.001).



Length of stay (LOS) was similar between primary drainage and primary conservative management (6.9 days vs. 4.8 days, p=0.072). LOS was significantly longer in patients needing salvage drainage compared to primary conservative patients (8.4 vs. 4.8 days, p=0.009). LOS after drain placement was similar regardless of salvage or primary approach (5.5 days vs 6.9 days, p = 0.63).



10 patients underwent surgery. Of these, 6 were primary, and 4 followed primary (1) or salvage (3) drainage. Grade 3 AEs (Clavien-Dindo Severity Scale) were observed in 3 (30%) patients.



No other severe AEs were observed. All patients had similar symptoms and clinical signs on presentation and similar white blood cell counts.

Conclusion: Catheter drainage is effective for TOA primarily and after failure of conservative medical therapy; intervention should be considered as primary treatment for TOA larger than 5 cm to reduce LOS. Surgical management is associated with serious AEs in up to one third of cases.