Pelvic inflamation disease (PID)

ROLE OF LAPAROSCOPY IN THE MANAGEMENT OF PELVIC INFLAMATION DISEASE / TUBO-OVARIAN ABSCESS COMPARE TO OTHER MODALITIES

Https://www.laparoscopyhospital.com/role-of-laparoscopy-in-the-management-of-pelvic-inflamation-disease-tubo-ovarian-abscess-compare-to-other-modalites.html

Dr. SAMSON CHANDRA, SpOG. D.MAS

OBSTETRICIAN, GYNECOLOGIST AND LAPAROSCOPIC SURGEON
PLUIT HOSPITAL, JAKARTA, INDONESIA
MEMBER OF WORLD ASSOCIATION OF LAPAROSCOPIC SURGEON

ABSTRACT

Pelvic inflammatory disease (PID) is the most common cause of acute pelvic pain and infertility due to transport factor. Acute complications of pelvic inflammatory disease include tubo-ovarian complex and abscess (TOA), pyosalpinx, and peritonitis. At late sequelae of this patient can be suffer of chronic pelvic pain, infertily, ectopic pregnancy or lifethreathening peritonitis if this disease could not be identify

PID and/or TOA can be diagnosed clinically or with several modalities like ultrasound, CT scan and MR imaging. However, the gold standard of diagnosis is still laparoscopy, particularly for the questionable diagnosis although many experts do not agreed with as a routinely tool because of the invasive method and expensive for among certain people.

The recently advance of antibiotic and method of drainage of the abscess with CT scan or ultrasound guidance are other available modalities which also arise controversy

Nevertheless some specific roles of laparoscopy are irreplaceable by other modalities particularly for women in reproductive age, menopausal women, doubtful diagnosis and other special cases

AIM OF STUDY

Laparoscopy is the best single diagnostic test, but it is invasive and not routinely used in clinical practice. The management of PID especially with TOA is still debated. In this article the laparoscopic management of tubo-ovarian abscesses (TOA) was evaluated. The study sought to provide the role of laparoscopy in diagnostic and treatment, what the efficacy compared to conservative treatment and laparotomy, at what condition laparoscopy should be preferred choice, how far the conservative therapy could be applied and what is the outcome if there is a late in manage of this disease.

METHODOLOGY

This reviews of article in role of laparoscopy in the management of tubo-ovarian abscess was searched using search engine Google, Hirewire press, Springerlink, Pub Med, Yahoo and other linked references. The following search keywords were used: laparoscopy, TOA, tubo-ovarian abscess and PID

INTRODUCTION

A pocket of pus that forms during an infection of a fallopian tube and ovary is called a tubo-ovarian abscess. Tubo-ovarian abscesses can develop in women who have pelvic inflammatory disease (PID) [1].

Tubo-ovarian abscess (TOA) most commonly occurs in women of reproductive age. Upper genital tract infections and acute or chronic pelvic inflammatory disease (PID) are the primary causes in most cases. Findings show that TOA develops in up to 34% of patients hospitalized for PID. Symptomatic and subclinical infections can lead rapidly to TOA. Untreated TOA may rupture and result in lifethreatening peritonitis. Because it is one cause of chronic pelvic pain, and because it has a negative impact on fertility, TOA is a major health concern [2].

A tubo-ovarian abscess is usually diagnosed by physical exam or pelvic ultrasound. Some abscesses are found by surgical exploration of the abdomen (laparoscopy or laparotomy) [1] These abscesses are usually treated with antibiotics. Very large abscesses or abscesses that do not go away after antibiotic treatment may have to be drained. Draining may be done by using a large needle that is guided by ultrasound or by cutting into the abscess during laparoscopy or laparotomy. Sometimes the infected tube and ovary also have to be removed surgically [1].

PELVIC INFLAMATION DISEASE (PID)

PID is defined as an infection of the female upper genital tract involving any combination of the endometrium, fallopian tubes, pelvic peritoneum and contiguous structures [3, 4]. Many causes may lead to lower abdominal pain in women, including gynecologic disease or dysfunction (complications of pregnancy, acute infections, endometriosis, adnexal disorders, menstrual disorders), as well as gastrointestinal (appendicitis, gastroenteritis, inflammatory bowel disease), genitourinary (cystitis, pyelonephritis, nephrolithiasis), musculoskeletal and neurologic causes.

The most common infectious cause of lower abdominal pain in women is pelvic
inflammatory disease (PID).
PID is a polymicrobial infection with multiple microbial etiologies.
Most cases of PID are associated with more than one organism.
Pathogens can be categorized as sexually transmitted or endogenous organisms [3].

About 10% of women with PID will suffered infertile and 30% develop chronic pain. Up to 5% of women who subsequently conceive have an ectopic pregnancy. Spontaneous resolution of symptoms probably occurs in many women, but early initiation of treatment should be needed to prevent impairment of fertility [5]. Clinical improvement should occur within 3 days of initiating therapy. Consider further diagnostic test and/or laparoscopy if symptoms do not improve or worsen [6].