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Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: A Case Series and Literature Review.
J Pediatr Adolesc Gynecol. 2020 Dec 16 [Online ahead of print]JP

Abstract

STUDY OBJECTIVE

We investigated risk factors and common causes of tubo-ovarian abscess (TOA) in non-sexually active females in order to aid in earlier diagnosis, treatment, and improved outcomes.

DESIGN

This is a retrospective observational case series of all non-sexually active females younger than age 25 years who were diagnosed with TOA. Review of the existing literature was also performed.

SETTING

Academic tertiary care children's hospital.

PARTICIPANTS

Ten patients meeting study inclusion criteria were identified for the study, and 33 other patients were identified in the literature.

RESULTS

Average age at time of diagnosis was 14 years. Average body mass index was 24 kg/m2. Most presented with abdominal pain, often associated with fevers, nausea, vomiting, and diarrhea. Seven of 10 patients were treated surgically with pelvic washout (4 primarily and 3 after failing empiric antibiotic therapy). Most frequently, anaerobic gut flora were isolated on culture. All patients received broad-spectrum intravenous antibiotics, and were then discharged on a course of doxycycline and metronidazole or clindamycin. Three patients required additional admissions and multiple rounds of antibiotics due to persistent symptoms. The average length of stay was 3 days for patients treated with antibiotics only and 6 days for patients requiring surgical intervention. Six patients had complete resolution of symptoms and improvement on ultrasound within 2-4 weeks. The remainder were lost to follow-up.

CONCLUSION

These cases, in conjunction with previous case reports, emphasize the importance of considering TOA in patients with concerning imaging or examination findings despite lack of sexual activity. Given the large proportion of cases attributable to anaerobic gut flora, treatment with antibiotics with adequate anaerobic coverage is recommended. Surgical drainage is not always necessary, but is often needed for diagnostic purposes or in patients not clinically improving with conservative measures.

Authors+Show Affiliations

Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: feiyf@med.umich.edu.Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33340647

Citation

Fei, Y Frances, et al. "Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: a Case Series and Literature Review." Journal of Pediatric and Adolescent Gynecology, 2020.
Fei YF, Lawrence AE, McCracken KA. Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: A Case Series and Literature Review. J Pediatr Adolesc Gynecol. 2020.
Fei, Y. F., Lawrence, A. E., & McCracken, K. A. (2020). Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: A Case Series and Literature Review. Journal of Pediatric and Adolescent Gynecology. https://doi.org/10.1016/j.jpag.2020.12.002
Fei YF, Lawrence AE, McCracken KA. Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: a Case Series and Literature Review. J Pediatr Adolesc Gynecol. 2020 Dec 16; PubMed PMID: 33340647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: A Case Series and Literature Review. AU - Fei,Y Frances, AU - Lawrence,Amy E, AU - McCracken,Kate A, Y1 - 2020/12/16/ PY - 2020/08/05/received PY - 2020/11/14/revised PY - 2020/12/04/accepted PY - 2020/12/20/pubmed PY - 2020/12/20/medline PY - 2020/12/19/entrez KW - Abdominal pain KW - Adolescent gynecology KW - Pelvic inflammatory disease KW - Pelvic pain KW - Tubo-ovarian abscess JF - Journal of pediatric and adolescent gynecology JO - J Pediatr Adolesc Gynecol N2 - STUDY OBJECTIVE: We investigated risk factors and common causes of tubo-ovarian abscess (TOA) in non-sexually active females in order to aid in earlier diagnosis, treatment, and improved outcomes. DESIGN: This is a retrospective observational case series of all non-sexually active females younger than age 25 years who were diagnosed with TOA. Review of the existing literature was also performed. SETTING: Academic tertiary care children's hospital. PARTICIPANTS: Ten patients meeting study inclusion criteria were identified for the study, and 33 other patients were identified in the literature. RESULTS: Average age at time of diagnosis was 14 years. Average body mass index was 24 kg/m2. Most presented with abdominal pain, often associated with fevers, nausea, vomiting, and diarrhea. Seven of 10 patients were treated surgically with pelvic washout (4 primarily and 3 after failing empiric antibiotic therapy). Most frequently, anaerobic gut flora were isolated on culture. All patients received broad-spectrum intravenous antibiotics, and were then discharged on a course of doxycycline and metronidazole or clindamycin. Three patients required additional admissions and multiple rounds of antibiotics due to persistent symptoms. The average length of stay was 3 days for patients treated with antibiotics only and 6 days for patients requiring surgical intervention. Six patients had complete resolution of symptoms and improvement on ultrasound within 2-4 weeks. The remainder were lost to follow-up. CONCLUSION: These cases, in conjunction with previous case reports, emphasize the importance of considering TOA in patients with concerning imaging or examination findings despite lack of sexual activity. Given the large proportion of cases attributable to anaerobic gut flora, treatment with antibiotics with adequate anaerobic coverage is recommended. Surgical drainage is not always necessary, but is often needed for diagnostic purposes or in patients not clinically improving with conservative measures. SN - 1873-4332 UR - https://www.unboundmedicine.com/medline/citation/33340647/Tubo-Ovarian_Abscess_in_Non-Sexually_Active_Adolescent_Girls:_A_Case_Series_and_Literature_Review. L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-3188(20)30398-3 DB - PRIME DP - Unbound Medicine ER -
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