A 31-year-old woman admitted with a right tubo-ovarian abscess on intravenous antibiotics suddenly develops generalised abdominal rigidity, heart rate 128 per minute, blood pressure 82/50 mmHg, and temperature 39.8 degrees Celsius. The MOST appropriate next step is:
- A Switch to broader spectrum antibiotics and continue conservative management
- B Immediate exploratory laparotomy with drainage and excision of the abscess ✓
- C Image-guided percutaneous drainage of the abscess
- D Repeat transvaginal ultrasound after 48 hours
Correct answer: B. Immediate exploratory laparotomy with drainage and excision of the abscess
Explanation
Sudden haemodynamic collapse with generalised peritonitis in a known tubo-ovarian abscess indicates rupture of the abscess into the peritoneal cavity, a surgical emergency with high mortality if delayed. Immediate laparotomy with source control alongside resuscitation and broad-spectrum antibiotics is required. Percutaneous drainage suits an intact unruptured abscess failing antibiotics, and continuing antibiotics alone or delaying imaging would be fatal mismanagement here.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.