A 26-year-old woman with a known 7 cm right tubo-ovarian abscess presents with sudden worsening of pain, hypotension (BP 82/50 mmHg), pulse 128/min, and guarding with rebound tenderness over the lower abdomen. What is the most appropriate next step in management?

• A Switch to broader spectrum intravenous antibiotics and reassess in 48 hours
• B Image-guided percutaneous drainage of the abscess
• C Repeat transvaginal ultrasound to look for interval change in abscess size
• D Immediate laparotomy ✓

Explanation

Sudden haemodynamic collapse with peritonism in a woman with a tubo-ovarian abscess indicates rupture of the abscess with free spillage of pus into the peritoneal cavity. Rupture is a surgical emergency requiring immediate laparotomy with lavage and excision or drainage of the source; antibiotics alone carry a very high mortality. Percutaneous drainage suits an intact abscess failing antibiotics, not a ruptured one with septic shock.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.