In a woman with suspected pelvic inflammatory disease (PID) who has a tubo-ovarian abscess of 4 cm detected on ultrasound, she remains febrile after 72 hours of IV antibiotics. The MOST appropriate next step is:
- A Change to oral antibiotics and discharge
- B Laparoscopic drainage or aspiration of the abscess ✓
- C Immediate open laparotomy for salpingo-oophorectomy
- D CT-guided percutaneous drainage
Correct answer: B. Laparoscopic drainage or aspiration of the abscess
Explanation
Tubo-ovarian abscesses (TOA) that fail to respond to IV antibiotics after 48–72 hours require drainage. Laparoscopic drainage/aspiration is the preferred minimally invasive approach and is associated with preservation of fertility. Larger abscesses (>8 cm) or complex multiloculated TOA may require CT-guided percutaneous drainage or open surgery. Immediate salpingo-oophorectomy is reserved for ruptured TOA or cases where conservative drainage fails. Oral antibiotics alone would be inadequate for a persistent TOA.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.