Exploring the Heterogeneity of Tubo-ovarian Abscess: A Case Series Revealing Diverse Clinical Scenarios

Though low, there is a risk of a TOA secondary to oocyte retrieval in women with endometriomas undergoing in vitro fertilization. 6,7he prevalence of PID and TOA is significantly higher among women with endometriosis.Genital tract infections and spontaneous rupture of endometriotic cysts are implicated in the occurrence of TOAs associated with ovarian endometriosis. [8][9][10] Possible mechanisms postulated are an immunologically abnormal condition in endometriosis, which can make pelvic organs more susceptible to infection; the weakened cystic wall of endometriomas may be more prone to bacterial invasion compared to healthy ovarian epithelium; and the presence of blood within IntroductIonA tubo-ovarian abscess (TOA) is a serious complication that arises in approximately 15-30% of women with pelvic inflammatory disease (PID) and predominantly affects women of reproductive age, with a peak incidence in the age-group of 20-40 years.It is characterized by the formation of an infected collection involving the fallopian tubes and ovaries.The clinical manifestations of a TOA include the presence of an adnexal mass, fever, leukocytosis, pelvic pain, dyspareunia, and vaginal discharge. [1][2]2][3] However, the presentations of this disease can exhibit significant variability, ranging from having an asymptomatic mass to rupture, peritonitis, and sepsis.The management of TOA poses significant challenges due to its potential for long-term complications and the risk of poor reproductive outcomes.This case series aims to present and analyze three distinct cases of TOA, highlighting the diverse clinical scenarios encountered in practice.By examining these cases, we aim to enhance our understanding of the condition and provide valuable insights into diagnosis and treatment strategies.The pathogenesis of TOA involves ascending infection from the lower genital tract, primarily through the fallopian tubes.The most common microorganisms that were recovered from these TOAs were chlamydia species, Escherichia coli, Neisseria gonorrhoeae, Bacteroides fragilis, Bacteroides species, Peptostreptococcus, Peptococcus, and aerobic streptococci. 4,5The risk factors associated with the development of TOA are similar to those for sexually transmitted infections (STI), which include a history of previous STI/PID, intrauterine device use, sexual activity at an early age, multiple sexual partners, immunosuppression, and poor healthcare.Infection also occurs via childbirth, abortion (therapeutic or elective), endometrial biopsy, and hysterosalpingogram (HSG).