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Tubo-ovarian abscess etiology, presentation, and management in youth and adolescents
Garrett Garbo1, Stephanie Cizek2
1University of Minnesota, Department of Obstetrics, Gynecology, and Women's Health, MN, United States.
Insights
Tubo-ovarian abscesses (TOA) in children and adolescents require prompt diagnosis and tailored management. Treatment involves broad-spectrum antibiotics, with image-guided drainage as a key option, balancing risks for optimal outcomes.
Area of Science:
- Pediatric Gynecology
- Infectious Diseases
- Medical Imaging
Background:
- Tubo-ovarian abscesses (TOA) present unique diagnostic challenges in pediatric and adolescent populations compared to adults.
- Etiologies, clinical presentation, and evaluation methods differ significantly in younger patients.
Purpose of the Study:
- To review the distinct etiologies of TOA in pediatric and adolescent patients.
- To outline current recommendations for the evaluation and management of TOA in this demographic.
- To highlight differences in diagnosis and treatment compared to adult populations.
Main Methods:
- Review of current literature and clinical guidelines for TOA management in children and adolescents.
- Analysis of diagnostic criteria and treatment strategies, including medical and interventional approaches.
- Comparison of pediatric/adolescent TOA characteristics with those in adult patients.
Main Results:
- Intravenous (IV) broad-spectrum antibiotics are standard for all patients.
- Image-guided drainage can be a first-line treatment for high-risk patients or second-line for non-responders to IV antibiotics.
- Surgical intervention is reserved for unstable patients or those failing other treatments.
Conclusions:
- Management strategies must balance TOA complication risks with iatrogenic risks.
- Early and accurate diagnosis is crucial for effective treatment in pediatric and adolescent TOA.
- Tailored management, including judicious use of antibiotics and image-guided drainage, improves outcomes.
Abstract:
Tubo-ovarian abscesses (TOA) in children and adolescents may be missed or delayed in diagnosis due to differences in the etiologies, presentation, and clinical evaluation compared to adult patients. Management of TOA should include intravenous (IV) broad-spectrum antibiotics for all patients; additional abscess drainage through image-guided techniques may be co-initiated with antibiotics as first line treatment for those with risk factors for treatment failure, or reserved as second-line treatment for those who do not improve with IV antibiotics. Surgical interventions impose a higher risk of complications and are generally reserved for clinically unstable patients or for those who fail both IV antibiotics and image-guided abscess drainage. Selection of management must balance complication risk of the TOA itself with iatrogenic complication risks. This article reviews TOA in the pediatric and adolescent population, highlighting the different etiologies in younger patients compared to adults, and reviewing current recommendations for evaluation and management.
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