Q: 64 years old postmenopausal woman presented with abdominal pain and sepsis-like picture. CT scan of abdomen raises high suspicion of Tubo-Ovarian abscess (TOA). What is the biggest concern?
Answer: Malignancy
Age plays an important role in the causality of TOA. Premenopausal patients develop TOA mostly due to Pelvic Inflammatory Disease (PID). TOA in postmenopausal women raises a strong suspicion of underlying malignancy. These patients should be strongly considered for full staging procedure besides treatment of TOA with antibiotics and/or drainage of the abscess.
If surgery is performed it requires an experienced surgeon who can explore the abdomen and pelvis fully to evaluate for metastatic disease and staging for cancer.
#surgical-critical-care
#ob-gyn
Reference:
Protopapas AG, Diakomanolis ES, Milingos SD, et al. Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol 2004; 114:203.
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