1
|
Mayan D, Melton CS, Sanderford VL, Camps JI, Tomlin KV. Surgical Treatment of Bilateral Tubo-Ovarian Abscess in a Pre-Coitarchal Female. Am Surg 2023; 89:6206-6208. [PMID: 35768199 DOI: 10.1177/00031348221112264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease that is most commonly seen in sexually active females and seldom in pre-coitarchal adolescents. Initial treatment is generally parenteral antibiotics but often requires more invasive surgical procedures. We present the case of a 12-year-old, non-sexually active adolescent, with bilateral TOA who ultimately underwent a sterilizing bilateral salpingectomy and appendectomy for treatment.
Collapse
Affiliation(s)
- Danel Mayan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | | | | | - Juan I Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital Midlands, Columbia, SC, USA
| | - Kristl V Tomlin
- Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Prisma Health Midlands, Columbia, SC, USA
| |
Collapse
|
2
|
Kobayashi H. Similarities in Pathogenetic Mechanisms Underlying the Bidirectional Relationship between Endometriosis and Pelvic Inflammatory Disease. Diagnostics (Basel) 2023; 13:diagnostics13050868. [PMID: 36900012 PMCID: PMC10000848 DOI: 10.3390/diagnostics13050868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Endometriosis is a common inflammatory disease characterized by the presence of endometrial cells outside of the uterine cavity. Endometriosis affects 10% of women of reproductive age and significantly reduces their quality of life as a result of chronic pelvic pain and infertility. Biologic mechanisms, including persistent inflammation, immune dysfunction, and epigenetic modifications, have been proposed as the pathogenesis of endometriosis. In addition, endometriosis can potentially be associated with an increased risk of pelvic inflammatory disease (PID). Changes in the vaginal microbiota associated with bacterial vaginosis (BV) result in PID or a severe form of abscess formation, tubo-ovarian abscess (TOA). This review aims to summarize the pathophysiology of endometriosis and PID and to discuss whether endometriosis may predispose to PID and vice versa. METHODS Papers published between 2000 and 2022 in the PubMed and Google Scholar databases were included. RESULTS Available evidence supports that women with endometriosis are at increased risk of comorbid PID and vice versa, supporting that endometriosis and PID are likely to coexist. There is a bidirectional relationship between endometriosis and PID that shares a similar pathophysiology, which includes the distorted anatomy favorable to bacteria proliferation, hemorrhage from endometriotic lesions, alterations to the reproductive tract microbiome, and impaired immune response modulated by aberrant epigenetic processes. However, whether endometriosis predisposes to PID or vice versa has not been identified. CONCLUSIONS This review summarizes our current understanding of the pathogenesis of endometriosis and PID and discusses the similarities between them.
Collapse
Affiliation(s)
- Hiroshi Kobayashi
- Department of Gynecology and Reproductive Medicine, Ms.Clinic MayOne, Kashihara 634-0813, Japan;
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara 634-8522, Japan
| |
Collapse
|
3
|
Boleken ME, Günendi T, Yol C, Kaya V, Kocaman OH, Dörterler ME. Xanthogranulomatous Salpingitis Presenting as Pyosalpinx in a Non-Sexually Active Adolescent Girl. J Pediatr Adolesc Gynecol 2023; 36:324-327. [PMID: 36764511 DOI: 10.1016/j.jpag.2023.01.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/27/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Although pelvic inflammatory disease is seen in sexually active women, it can also be seen in virgin girls. One of the conditions that can develop if not treated appropriately is pyosalpinx. A case of pyosalpinx causing xanthogranulomatous inflammation, a rare type of inflammation, is presented. CASE A 15-year-old virgin adolescent patient underwent salpingectomy for left pyosalpinx, and the pathology result revealed xanthogranulomatous salpingitis. CONCLUSION Pelvic inflammatory disease is extremely rare in virgin adolescents and there is usually an underlying anatomic anomaly. No anatomical anomaly was detected in our case, but the detection of E.coli in the abscess fluid culture and the chronic constipation of our patient made us think that the cause of the disease was an ascending infection originating from the gastrointestinal tract.
Collapse
Affiliation(s)
- Mehmet Emin Boleken
- Harran University Medical Faculty, Department of Pediatric Surgery, Şanlıurfa, Turkey.
| | - Tansel Günendi
- Harran University Medical Faculty, Department of Pediatric Surgery, Şanlıurfa, Turkey
| | - Cansu Yol
- Mehmet Akif İnan Training and Research Hospital, Department of Pathology, Şanlıurfa, Turkey
| | - Veysel Kaya
- Harran University Medical Faculty, Department of Radiology, Şanlıurfa, Turkey
| | - Osman Hakan Kocaman
- Harran University Medical Faculty, Department of Pediatric Surgery, Şanlıurfa, Turkey
| | | |
Collapse
|
4
|
Systematic Review and Meta-Analysis of Complications after Laparoscopic Surgery and Open Surgery in the Treatment of Pelvic Abscess. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3650213. [PMID: 35832848 PMCID: PMC9273437 DOI: 10.1155/2022/3650213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022]
Abstract
Background Pelvic abscess surgery consists mostly of open laparotomy and laparoscopic surgery. Open surgery is regarded as a classic procedure. With the rise and promotion of laparoscopic indications in recent years, comparative studies of the two's postoperative effectiveness have been limited. Objective To compare the clinical effects of laparoscopic exploratory surgery and open surgery in the treatment of pelvic abscess. Methods Through computer searches of PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, we found publicly available case-control research on laparoscopic surgery and open surgery for treating pelvic abscess. The papers that met the evaluation criteria were screened, and meta-analysis was used to look at 8 papers on laparoscopic surgery and open surgery for treating pelvic abscess from 2010 to 2021. Results The results of this study showed that compared with the open laparotomy group, the incidence of laparoscopic group in the incision infection rate (RR = 0.29, 95% CI (0.20, 0.41), and P < 0.00001), the incidence of intestinal injury (RR = 0.08, 95% CI (0.04, 0.14), and P < 0.00001), incidence of intestinal obstruction (RR = 0.26, 95% CI (0.08, 0.90), and P = 0.03 < 0.05), and postoperative pelvic abscess recurrence rate (RR = 0.34, 95% CI (0.13, 0.86), and P = 0.02 < 0.05) are lower than open surgery, and the difference of these four items is statistically significant. There was no difference in the risk of urinary tract injury between laparoscopic surgery and open surgery (RR = 0.92, 95% CI (0.27, 3.17), and P = 0.89 > 0.05). Conclusion In terms of incision infection, intestinal damage, intestinal obstruction, and recurrence of pelvic abscess, the laparoscopic group clearly outperforms the open group, and it merits clinical promotion and use.
Collapse
|
5
|
Purwar R, Soni K, Tilak R, Verma A, Pandey M. Tubo-ovarian mass with raised CA-125 in a 21-year-old female. World J Surg Oncol 2022; 20:188. [PMID: 35676687 PMCID: PMC9178888 DOI: 10.1186/s12957-022-02651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Peritonitis associated with fungal species Curvularia lunata seldom occurs with only five cases reported in the literature, all in middle-age patients with comorbidities undergoing dialysis. Case report A 21-year-old female who was referred to surgical oncology OPD with a diagnosis of ovarian malignancy, based on raised cancer antigen 125 (CA 125) and suspected tubo-ovarian mass (TOM) on magnetic resonance imaging (MRI). A review of the MRI showed a pelvic collection with TOM, suggestive of infective pathology. Fungal culture and mass spectroscopy of the cystic collection identified the presence of Curvularia lunata. She was treated with oral itraconazole which showed symptomatic improvement and radiological response. In the follow-up period, the patient developed chest wall swelling, aspiration and geneXpert® revealed multidrug-resistant (MDR) tuberculosis, and treatment was started. Conclusions Unusual causes of TOM and raised CA 125 should be kept in mind when dealing with young patients, as the possibility of epithelial ovarian cancer in this age is very low. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02651-w.
Collapse
Affiliation(s)
- Roli Purwar
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
| | - Kishan Soni
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Ragini Tilak
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
| |
Collapse
|
6
|
Liu W, Zhang Z, Li D. Primary ovarian abscess in virginal young woman with huge endometriosis cyst: A case report. Medicine (Baltimore) 2022; 101:e29463. [PMID: 35623079 PMCID: PMC9276374 DOI: 10.1097/md.0000000000029463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/26/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Primary ovarian abscess which develops as an isolated lesion without simultaneous tubal infection is a rare entity. Ovarian abscess (OA) is a serious complication of pelvic inflammatory disease (PID) rarely seen in virginal girls. Early diagnosis and treatment are essential to prevent further sequela including infertility, ectopic pregnancy, and chronic pelvic pain. PATIENT CONCERNS A 19-year-old virginal girl who presented with abdominal pain and pelvic mass with no risk factors. DIAGNOSES Laparoscopic surgery was performed to confirm a primary ovarian abscess in the adolescent virginal female with a huge endometriosis cyst. INTERVENTION Ovarian abscess with extensive intestinal adhesions was determined during the laparoscopic operation. Abscess drainage and postoperative antibiotic therapy cured the patient. OUTCOME After the surgery, the CRP level on the day of discharge was 3.18 mg/d. The histological findings revealed a cystic tissue sample with the fibrous wall infiltrated by neutrophilic granulocytes, and ectopic endometrium, suggesting abscess formation in the ovary and endometriosis cyst. LESSONS Although primary ovarian abscess in an adolescent virginal female is rare, given the severity of outcomes following ovarian abscess, this pathology should be considered in the differential diagnosis of virginal adolescents with fever and abdominal pain.
Collapse
|
7
|
Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Tubo-ovarian abscess. Am J Emerg Med 2022; 57:70-75. [DOI: 10.1016/j.ajem.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022] Open
|
8
|
Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312718. [PMID: 34886447 PMCID: PMC8656947 DOI: 10.3390/ijerph182312718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 12/29/2022]
Abstract
The incidence of acute appendicitis decreased in Western countries from 1930 to at least the early 1990s, when epidemiological data started becoming scarcer. This study aimed to assess the trend in annual hospitalizations for acute appendicitis in all people Spain for a 20-year period between 1998 and 2017. This observational study analyzing direct age-standardized hospital admission rates by gender and age group (0–14 years, 15–34 years, 35–44 years, 45–64 years, and ≥65 years). Joinpoint regression models were fitted to evaluate changes in trends. There were 789,533 emergency hospital admissions for acute appendicitis between 1998 and 2017: 58.9% in boys and men and 41.1% in girls and women. Overall, there was a significant increase in admissions for this cause from 1998 to 2009, with an annual percent change (APC) of 0.6%. Following the peak in 2009, admission rates decreased by around 1.0% annually until 2017. The length of hospital stay gradually decreased from 4.5 days in 1998 to 3.4 days in 2017. The trends in hospital admissions for acute appendicitis in Spain changed over the study period, decreasing from 2009, especially in people younger than 35 years.
Collapse
|
9
|
Kim S, Seo H, Rahim MA, Tajdozian H, Kim YS, Song HY. Characteristics of Vaginal Microbiome in Women with Pelvic Inflammatory Disease in Korea. Pol J Microbiol 2021; 70:345-357. [PMID: 34584529 PMCID: PMC8458998 DOI: 10.33073/pjm-2021-033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 01/03/2023] Open
Abstract
Human vaginal microorganisms play an important role in maintaining good health throughout the human life cycle. An imbalance in the vaginal microbiota is associated with an increased risk of pelvic inflammatory disease (PID). This study aimed to characterize and compare vaginal microbial profiles of premenopausal Korean women with and without PID. 74 Korean premenopausal female vaginal samples were obtained; 33 were from healthy women (a control group) and 41 from PID patients. Vaginal fluid samples were collected from the vaginal wall and posterior cervix and then analyzed by 16S ribosomal ribonucleic acid (rRNA) gene-based amplicon sequencing. Results showed a significant difference between the vaginal microbial communities of the two groups (Jensen-Shannon, p = 0.014; Bray-Curtis, p = 0.009; Generalized UniFrac, p = 0.007; UniFrac, p = 0.008). Lactobacillus accounted for the highest percentage (61.0%) of the control group but was significantly decreased (34.9%) in PID patients; this was the most significant difference among all bacterial communities (p = 0.028, LDA effect size = 5.129). In addition, in the PID patient group, species diversity significantly increased (Simpson, p = 0.07) as the proportion of various pathogens increased evenly, resulting in a polymicrobial infection. Similarly, lactate, which constituted the highest percentage of the organic acids in the control group, was significantly decreased in the PID patient group (p = 0.04). The present study's findings will help understand PID from the microbiome perspective and are expected to contribute to the development of more efficient PID diagnosis and treatment modalities.
Collapse
Affiliation(s)
- Sukyung Kim
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, South Korea
| | - Hoonhee Seo
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, South Korea
| | - Md Abdur Rahim
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Hanieh Tajdozian
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Yun-Sook Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Ho-Yeon Song
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan, South Korea.,Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan, South Korea
| |
Collapse
|
10
|
Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
Collapse
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| |
Collapse
|
11
|
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 2021; 34:328-333. [PMID: 33340647 DOI: 10.1016/j.jpag.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/14/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022]
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.
Collapse
Affiliation(s)
- Y Frances Fei
- Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Amy E Lawrence
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Kate A McCracken
- Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
12
|
Murata T, Endo Y, Furukawa S, Ono A, Kiko Y, Soeda S, Watanabe T, Takahashi T, Fujimori K. Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature. BMC WOMENS HEALTH 2021; 21:198. [PMID: 33985484 PMCID: PMC8116819 DOI: 10.1186/s12905-021-01335-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/28/2021] [Indexed: 12/04/2022]
Abstract
Background Ovarian abscesses, which occur mostly in sexually active women via recurrent salpingitis, occur rarely in virginal adolescent girls. Here, we present a case of an ovarian abscess in a virginal adolescent girl who was diagnosed and treated by laparoscopy. Case presentation A 13-year-old healthy girl presented with fever lasting for a month without abdominal pain. Computed tomography scan and magnetic resonance imaging indicated a right ovarian abscess. Laparoscopic surgery revealed a right ovarian abscess with intact uterus and fallopian tubes. The abscess was caused by Staphylococcus aureus. The patient recovered completely after excision of the abscess, followed by antibiotic treatment. Conclusions Ovarian abscess may occur in virginal adolescent girls; Staphylococcus aureus, an uncommon species causing ovarian abscess, may cause the infection.
Collapse
Affiliation(s)
- Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
| | - Yuta Endo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Atsushi Ono
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Yuichiroh Kiko
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| |
Collapse
|
13
|
Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
Collapse
Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| |
Collapse
|
14
|
Yang Z, Sun F, Ai S, Wang J, Guan W, Liu S. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg 2019; 19:110. [PMID: 31412833 PMCID: PMC6694559 DOI: 10.1186/s12893-019-0578-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Appendectomy is considered the first treatment choice for appendicitis. However, controversy exists since conservative therapy is associated with fewer complications than appendectomy for patients with acute appendicitis (AA). This meta-analysis aimed to compare the outcomes between conservative therapy and appendectomy in the management of adult AA. METHODS A literature search was performed to screen eligible clinical studies. Subgroup analyses of the uncomplicated population, complicated population and mixed population of randomized clinical trials were subsequently performed. Clinical outcomes included the overall effective rate of treatment, complication rate, relapse rate (reoperation rate) and overall length of stay (LOS). RESULTS Eleven trials totalling 2751 patients (conservative = 1463, appendectomy = 1288) were analysed. Patients receiving conservative treatment had a lower overall effective rate (OR: 0.11 ~ 0.17) and complication rate (OR: 0.21 ~ 0.51). The conservative group had a higher reoperation rate (5.6, 95% CI: 3.1% ~ 10.2%) than the appendectomy group (OR: 9.58 ~ 14.29). Conservative treatment was associated with a shorter overall length of stay (0.47 day, 95% CI: 0.45 ~ 0.5 day) than appendectomy. CONCLUSIONS For both uncomplicated and complicated adult AA, non-operative management with antibiotics was associated with significantly fewer complications and a shorter length of stay but a lower effective rate and higher relapse rate.
Collapse
Affiliation(s)
- Zhengyang Yang
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Feng Sun
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Shichao Ai
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Jiafeng Wang
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China
| | - Wenxian Guan
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China.
| | - Song Liu
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China.
| |
Collapse
|
15
|
Tubo-Ovarian Abscesses in Nonsexually Active Adolescent Females: A Large Case Series. J Adolesc Health 2019; 65:303-305. [PMID: 31196784 DOI: 10.1016/j.jadohealth.2019.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/06/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to review the incidence, presentation, and management of tubo-ovarian abscesses (TOA) in nonsexually active (NSA) adolescents. METHODS A retrospective chart review was performed at a single children's hospital. We evaluated self-reported NSA females aged < 21 years diagnosed with TOA. Demographics, presenting symptoms, medical history, laboratory studies, imaging, and treatment were reviewed. RESULTS Sixteen NSA females met inclusion criteria, with one patient presenting with two separate TOAs. Mean age at diagnosis was 14.6 ± 1.8 years; all were menarchal. Presenting symptoms included abdominal pain (88%), fever (76%), and vomiting (53%). Eleven patients (65%) received transabdominal pelvic ultrasound, 2 (12%) had magnetic resonance imaging of pelvis, and 11 (65%) had computed tomography of abdomen/pelvis. All patients had negative gonorrhea and chlamydia testing. Thirteen (76%) had comorbid disease including obstructed hemivagina ipsilateral renal agenesis, active or recent appendicitis, or genitourinary tract anomalies. Sixteen cases underwent drainage via interventional radiology or surgery. Twelve cases (71%) had TOA fluid cultured; five (29%) grew Escherichia coli species. All cases received intravenous antibiotics, and 88% of cases continued outpatient oral antibiotics. CONCLUSIONS Although uncommon in NSA females, patients with underlying comorbidities may be at increased risk for TOA formation. Providers should consider the diagnosis of TOA even in NSA females.
Collapse
|
16
|
Pfeifer CM, Williams LE, Veltkamp JG, Lagomarsino EM. Pediatric pyosalpinx without sexually transmitted infection: A report of 3 cases. Radiol Case Rep 2019; 14:501-504. [PMID: 30815048 PMCID: PMC6377389 DOI: 10.1016/j.radcr.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/29/2022] Open
Abstract
Pelvic inflammatory disease commonly occurs in adults and is most frequently caused by sexually-transmitted organisms. When left untreated, it can progress to abscess formation and subsequent infertility due to tubal scarring. This condition rarely occurs in the pediatric population and even less frequently in the absence of sexual activity. The cases presented here depict 3 cases of pyosalpinx due to noncommunicable infectious agents. Since children are typically not subjected to transvaginal ultrasound, they are particularly at risk for delays in diagnosis and appropriate treatment. Cases described here also demonstrate the value of the pediatric interventional radiology service in treating this gynecological source of infection. Both transabdominal and transrectal approached to ultrasound-guided drainage are described.
Collapse
|
17
|
Hurni Y, Bonollo M, Ferrero L, Taraschi G, Canonica C, Venturelli Reyes Lozano S. Pyosalpinx complicating chronic hydrosalpinx in a 50-year old virgo woman: a case report. BMC WOMENS HEALTH 2018; 18:90. [PMID: 29890968 PMCID: PMC5996547 DOI: 10.1186/s12905-018-0583-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/05/2018] [Indexed: 11/23/2022]
Abstract
Background Pelvic inflammatory disease is an infection of the upper genital tract, including the uterus, ovaries, uterine tubes, and pelvic peritoneum. Tubo-ovarian abscess and pyosalpinx are common complications associated with pelvic inflammatory disease. They are usually encountered in sexually active women, but rare cases in Virgos have also been described. Case presentation Here, we report the case of a 50-year-old Virgo woman presenting with pyosalpinx secondary to previous laparotomic sigmoidectomy for acute diverticulitis. Inflammation caused by the woman’s diverticulitis and laparotomic surgery could have been the origin of her left uterine tube occlusion and consequent hydrosalpinx development. The contact between the rectum and left uterine tube observed in our patient suggests that superinfection of the hydrosalpinx could have occurred secondary to bacterial translocation. The patient’s condition was managed with laparoscopic left salpingectomy and antibiotic therapy, which resulted in complete resolution. Conclusions Regardless of sexual history, pelvic inflammatory disease should be considered in all women with abdominal pain. Diagnosing pelvic inflammatory disease in Virgos could be very challenging, but its recognition and appropriate treatment are indispensable because of the potential long-term complications.
Collapse
Affiliation(s)
- Yannick Hurni
- Department of Obstetric and Gynecology, Ospedale Regionale Bellinzona e Valli, 6500, Bellinzona, Switzerland.
| | - Marta Bonollo
- Department of Obstetric and Gynecology, Ospedale Regionale Bellinzona e Valli, 6500, Bellinzona, Switzerland
| | - Ludovica Ferrero
- Department of Obstetric and Gynecology, Ospedale Regionale Bellinzona e Valli, 6500, Bellinzona, Switzerland
| | - Gianmarco Taraschi
- Department of Obstetric and Gynecology, Ospedale Regionale Bellinzona e Valli, 6500, Bellinzona, Switzerland
| | - Claudia Canonica
- Department of Obstetric and Gynecology, Ospedale Regionale Bellinzona e Valli, 6500, Bellinzona, Switzerland
| | | |
Collapse
|
18
|
Tuba-ovarian abscess in a sexually inactive teenager with Down syndrome: Case report and brief review of literature. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.417557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Egbe TO, Kobenge FM, Arlette MMJ, Belley-Priso E. Pyosalpinges after hysterosalpingography in a patient with lower genital tract infection and managed by laparoscopic surgery in a resource low tertiary hospital case report and literature review. FERTILITY RESEARCH AND PRACTICE 2018; 4:2. [PMID: 29686882 PMCID: PMC5898046 DOI: 10.1186/s40738-018-0047-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/20/2018] [Indexed: 11/10/2022]
Abstract
Background Pyosalpinges (a complication of pelvic inflammatory disease) is infection of the fallopian tubes and the morbidity associated with it has major health implications. We are reporting a case of pyosalpinges diagnosed after hysterosalpingography and managed by laparoscopic surgery at the Douala General Hospital, Cameroon. Case presentation A 29-year-old single woman, an assistant nurse of the Douala tribe in Cameroon. She is G1P0010 and came to our attention because of secondary infertility of three years duration. She has a history consistent with four lifetime sexual partners, self-medication for chlamydia trachomatis infection and induced abortion by dilatation and aspiration. Furthermore, she is HIV positive and had an ultrasound scan suggestive of bilateral hydrosalpinges. After a hysterosalpingography examination she developed painless muco-purulent vaginal discharge and bilateral adnexal tenderness on bimanual examination suggestive of pyosalpinges. Vaginal and cervical cultures isolated Ureaplasma urealyticum and Gardnerella vaginalis sensitive to ofloxacin and metronidazole, respectively.At laparoscopy, bilateral pyosalpinges, pelvic adhesions and peri-hepatic adhesions were found. Bilateral salpingectomy with adhesiolysis including lysis of perihepatic adhesions and peritoneal toileting was done. She was discharged from hospital 72 h later and her hospital stay was uneventful. She was counseled for in-vitro fertilization and to register in the national HIV treatment programme. Her husband was prescribed ofloxacin empirically. Conclusion Antimicrobial prophylaxis should be given to patients prior to HSG, especially those with a history of chlamydia or evidence of hydrosalpinges. There should also be universal STI testing in high risk and HIV positive patients or the danger for suboptimal antibiotic usage in areas where self-medication is common.In resource-low tertiary hospitals where computed tomography or magnetic resonance imaging is not readily available and/or affordable, clinical examination and pelvic ultrasound remains the key diagnostic tool. Surgical treatment is the best option for pyosalpinges and when plausible, laparoscopic surgery is the treatment of choice. Laparotomy is the mainstay in most hospitals in Cameroon. The parent of the patient did not consent to histo-pathologic examination.
Collapse
Affiliation(s)
- Thomas Obinchemti Egbe
- 1Faculty of Health Sciences, University of Buea and Department of Obstetrics and Gynecology, Douala General Hospital, P.O. Box 63, Buea, Cameroon
| | - Fidelia Mbi Kobenge
- Department of Obstetrics and Gynecology, Douala General Hospital, Douala, Cameroon
| | | | - Eugene Belley-Priso
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1 and Department of Obstetrics and Gynecology, Douala General Hospital, Douala, Cameroon
| |
Collapse
|
20
|
Munro K, Gharaibeh A, Nagabushanam S, Martin C. Diagnosis and management of tubo-ovarian abscesses. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/tog.12447] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kirsty Munro
- Department of Obstetrics and Gynaecology; Royal Infirmary of Edinburgh; Edinburgh EH16 4SA UK
| | - Asma Gharaibeh
- Department of Obstetrics and Gynaecology; Royal Infirmary of Edinburgh; Edinburgh EH16 4SA UK
| | - Sangeetha Nagabushanam
- Department of Obstetrics and Gynaecology; Royal Infirmary of Edinburgh; Edinburgh EH16 4SA UK
| | - Cameron Martin
- Department of Obstetrics and Gynaecology; Royal Infirmary of Edinburgh; Edinburgh EH16 4SA UK
| |
Collapse
|
21
|
Chapa HO, Dawson D, Brading K, Hodnett M, Zimmermann R, Teke M. Non-Sexual Pelvic Inflammatory Disease in a Virginal Patient Resulting in Catatonic Conversion Reaction. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|