A 33-year-old woman with a ruptured tubo-ovarian abscess presents with hypotension, generalized guarding, and rigidity. After resuscitation and broad-spectrum antibiotics, the definitive next step is:
- A Immediate exploratory laparotomy with drainage and removal of pus ✓
- B Ultrasound-guided percutaneous drainage of the pelvis
- C Continue intravenous antibiotics alone and reassess in 72 hours
- D Hysterosalpingography to define the anatomy before surgery
Correct answer: A. Immediate exploratory laparotomy with drainage and removal of pus
Explanation
Rupture of a tubo-ovarian abscess with generalized peritonitis and septic shock is a surgical emergency requiring immediate laparotomy, drainage of pus, and usually hysterectomy with bilateral salpingo-oophorectomy in women who have completed childbearing. Expectant management or delayed drainage carries high mortality. HSG is absolutely contraindicated in this setting as it can disseminate infection.
Reference: Williams Gynecology, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.