Powers Kenneth, Lazarou George, Greston Wilma Markus, Mikhail Magdy
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA.
J Reprod Med. 2007 Mar;52(3):235-7.
Rupture of a tuboovarian abscess is a life-threatening emergency. The current standard of care is surgery to manage the onset of peritonitis and sepsis.
A 34-year-old woman presented with gradually worsening abdominal pain over several weeks. She had fever, pelvic tenderness, an elevated white blood cell count and ultrasonographic evidence of a tuboovarian abscess. After 48 hours of triple antibiotic therapy without a clinical improvement, she underwent surgery, during which she was found to have an abscess that had ruptured into the abdominal wall. A supracervical hysterectomy/bilateral salpingo-oophorectomy and surgical debridement of the subcutaneous tissue was performed, with wet to dry dressing changes of the surgical wound. Over the following 18 months, the patient required extensive wound care for recurrent bouts of wound drainage.
Rupture of a tuboovarian abscess usually presents with sudden worsening of the patient's condition. Delays in surgical debridement and drainage increase the rate of associated mortality. Atypical presentations may present as cases resistant to conventional medical therapy, with fewer of the associated risks of life-threatening peritonitis and subsequent sepsis. Our patient represents the first reported case of extraperitoneal spillage of abscess contents from rupture of a tuboovarian abscess into the anterior abdominal wall.
输卵管卵巢脓肿破裂是一种危及生命的急症。当前的治疗标准是通过手术来处理腹膜炎和脓毒症的发作。
一名34岁女性，数周来腹痛逐渐加重。她有发热、盆腔压痛、白细胞计数升高以及输卵管卵巢脓肿的超声证据。在接受三联抗生素治疗48小时后病情无临床改善，她接受了手术，术中发现有一个脓肿已破裂至腹壁。实施了次全子宫切除术/双侧输卵管卵巢切除术以及皮下组织的手术清创，手术伤口采用湿-干换药。在接下来的18个月里，患者因伤口反复引流需要广泛的伤口护理。
输卵管卵巢脓肿破裂通常表现为患者病情突然恶化。手术清创和引流的延迟会增加相关死亡率。非典型表现可能表现为对传统药物治疗有抵抗的病例，伴有较少危及生命的腹膜炎及随后脓毒症的相关风险。我们的患者代表了首例报道的输卵管卵巢脓肿破裂后脓肿内容物腹膜外溢至前腹壁的病例。
