A 28-year-old woman presents with a 3-day history of lower abdominal pain, fever 38.4°C, purulent cervical discharge, and right adnexal tenderness. Transvaginal ultrasound shows a 5 cm complex thick-walled right adnexal cystic mass with internal echoes. She is haemodynamically stable. After IV antibiotics for 72 hours, there is no clinical improvement. The most appropriate next step is:
- A Ultrasound-guided transvaginal aspiration/drainage of tubo-ovarian abscess ✓
- B Continue antibiotics for another 72 hours
- C Immediate laparotomy and salpingo-oophorectomy
- D Change to oral antibiotics and discharge
Correct answer: A. Ultrasound-guided transvaginal aspiration/drainage of tubo-ovarian abscess
Explanation
A tubo-ovarian abscess (TOA) ≥9 cm failing intravenous antibiotics after 72 hours typically requires drainage. For abscesses <9 cm that fail 72 hours of IV antibiotics, image-guided drainage (transvaginal or transabdominal) is preferred over immediate surgery as it is less invasive and preserves fertility. Laparotomy with salpingo-oophorectomy is reserved for peritonitis, ruptured TOA, or failure of drainage. Continuing the same antibiotics without intervention after 72 hours of failure is not evidence-based.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.