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Low Invasive Imaging Guided Treatment of Tubo Ovarian Abscess Malkhaz Mizandari MD PhD Ultrasound Education Centre “GEOJEFF” State Medical University

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Low Invasive Imaging Guided Treatment of Tubo Ovarian Abscess Malkhaz Mizandari MD PhD Ultrasound Education Centre “GEOJEFF” State Medical University Powered By Docstoc
					Low-Invasive Imaging Guided
 Treatment of Tubo-Ovarian
         Abscess

    Malkhaz Mizandari, MD, PhD
     Ultrasound Education Centre
             “GEOJEFF”
       State Medical University
            Tbilisi, Georgia
            Etiology-Pathogenesis

TOA is a complication of PID
(15.0 to 30.0% of cases)
Pathogenesis
Ascending lower genital tract infection
Tube epithelium inflammation and necrosis
  a) Altered pH
  b) Devitalized or necrotic tissue from infection
  c) Impaired blood supply from edema
  d) Pathogenic organism growth
              Diagnosis
          - Clinical Findings
Pain in Small Pelvis
High Temperature
Vaginal Discharge (Purulent)
Painful Mass in Adnexal Region
Tenderness or Pain of Cervix on Physical
Examination
  Diagnosis - Imaging


Ultrasound
CT
MR imaging
        Ultrasound Diagnosis
Irregularly Shaped Mass in Adnexa
Thick Walls
Complex Mass (Predominantly Cystic)
 Internal Septi
 Fluid-Fluid Level
 Fluid-Debris level
 Gas (Gas-Forming Microorganizms)
 Often Adnexal Region Occupied Bilaterally
             Microbiology
 The Most Common Primary Causes:
a) Chlamydia trachomatis
 b) Neisseria gonorrhea

 Less Common
Gardneralla vaginalis, Peptostreptococcus sp,
 Streptococcus agalectiae, Ureaplasma sp,
 Mycobacterium tuberculosis, Haemophilus influenzae,
 Actinomyces

 Supplemented Infection
Escherichia Coli
                  Treatment
Medical (Broad Spectrum Antibiotics for PID)

TOA - Content Evacuation:
Surgery
Surgical options include laparoscopy or laparotomy with
 unilateral adnexectomy or total abdominal hysterectomy
 with bilateral oophorectomy
      Low-Invasive
      Intervention
 Imaging guided percutaneal or endocavity
aspiration/drainage:
a) CT b) Ultrasound c)Combined (Ultrasound-
Fluoroscopy)
   Invasive Ultrasound -
       Advantages
No Ionizing Radiation
Real-Time Technique
Doppler Capability
Puncture Aiming and Needle
Movement Guidance Capability
Abdominal and Endocavity
Approach
Cost-Saving
            Material and Methods
  TOA – 28 patients
  Percutaneal approach (Drainage) – 4 patients
  Perrectal approach (Aspiration, Rinsing) – 4
  patients
  Pervaginal approach (Aspiration, Rinsing) – 22
  patient
(Note – all patients received antibiotics according
  the findings of bacteriology of aspirated material)
                Procedures
Rinsing (Saline and Antiseptics) was performed
to all patients
Proteolythic Enzyme Injection was performed to
6 patients because of inadequate rinsing due
to TOA Septi and viscous content
Single Procedure - 7 patients total (2
percutaneal drainages and 5 aspirations)
2 procedures – 10 patients (among them – 1
after percutaneal drainage)
3 and more procedures – 11 patients (among
them – 1 after percutaneal drainage)
     Abdominal vs. endocavity
      approach - Indications
Abdominal Approach – Relatively Big
Mass, Fixed to Anterior Abdominal Wall
(advantage – Drainage Easily Performed)
Rectal Approach – Big Amount of Purulent
Vaginal Discharge, Painful Vaginal
Examination, Virgo Patient
Vaginal Approach – Small Masses Easily
Achievable for Puncture
Needle Inserted in TOA
Saline Injection
Rinsing (Bubbles in TOA cavity)
Betadine Injected
Aspiration (Cavity is Collapsing)
Aspiration (Cavity is Collapsing)
Aspiration (Cavity Collapsed)
               Results

Positive Result was Achieved in 27
(96.6%) cases
Open Surgery Required (Total
Abdominal Hysterectomy with Bilateral
Oophorectomy) – 1 (3.4 %) case
              Summary

Low-Invasive Treatment (LIT) under Imaging
Guidance Control Is Safe, Effective and Cost-
Saving Technique
LIT is Easily Tolerated by Patients (Multiple
Procedures)
Combination of Percutaneal Drainage and
Endocavity Aspiration Might Be Helpful
LIT Should Be Used as a First Choice Treatment
Procedure in TOA Patients Management

				
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posted:4/7/2008
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