[The primary isolated ovarian abscess. Clinical and bacteriological observations and a new pathogenetic hypothesis...

42 of 86 patients with suppurated ovaries had primary isolated ovarian abscesses (PIOA), 44 secondary tubo-ovarian abscesses (STOA). Parts of ectopic endometrium in the abscess wall could be identified by serial sections in 23 PIOA. With Berlin-blue-staining was a special phenomenon in 28 of 42 PIOA demonstrated: a basal layer of hemosiderophages underlying the abscess membrane. Thus in 36 of 42 PIOA the histogenesis out of cystic ovarian endometriosis or other pathologic ovarian hematomas is assured. The PIOA is a typical major complication of ovarian hematomas, especially in cases of ovarian endometriosis caused by vaginal aplasia (gynatresia). Concomitant salpingitis in PIOA is therefore often better explained as secondary descending infection from pelveoperitonitis. Before laparotomy it is extremely difficult to diagnose PIOA on a clinical basis only. More than laboratory data helps this special consideration if an inflammatory adnexal mass could be or not the result of an ascending infection and if an ovarian endometriosis could exist. Besides the abscesses out of cystic ovarian endometriosis PIOA were observed after hysterectomies and complicated appendectomies possible due to the infection of traumatic ovarian hematomas. The only curative therapy for PIOA is surgery--as soon as possible. Antibiotics are poorly helpful. However the inefficacy of antibiotics usually gives the final indication for laparotomy. Knowing the usual etiology of PIOA out of pathologic (endometriotic) ovarian hematomas we have new guidelines in other clinical problems also: Thus every ovarian endometriosis has to be cured--hormonally or surgically; evacuation of endometriotic cysts during pelvic endoscopy is not a sufficient therapy, for the endometrium would be left in the ovary. During operations provocation of traumatic hematomas of the adnexa should be avoided.