Follow-up of patients with tubo-ovarian abscess(es) in association with salpingitis.

The medical records of 143 patients hospitalized with a diagnosis of salpingitis over a five-year period were reviewed. Ninety-three patients had salpingitis without clinical evidence of a tubo-ovarian abscess. Seven (7.5%) of these women had surgical treatment; five of the seven were found to have tubo-ovarian abscesses which had not been detected clinically. Eighty-six of 93 (92.5%) patients with a clinical diagnosis of salpingitis and no abscess responded to medical management alone. Fifty patients had salpingitis and clinical evidence of a tubo-ovarian abscess(es); five of these patients had medical management only, 27 had medical treatment followed by surgery, and 18 had surgery initially before receiving antibiotics. There was a significant difference in age but not in parity between patients with evidence of a tubo-ovarian abscess that was managed medically and those who had surgery. There was no significant difference in surgical procedure performed, chronic symptoms, subsequent gynecologic surgery, or subsequent pregnancy among the groups with an abscess. There was a trend toward more surgical complications among women who had delayed surgical intervention for an abscess. Among women with a unilateral tubo-ovarian abscess, those who had a unilateral salpingo-oophorectomy had a higher pregnancy rate than those who received antibiotics alone. In this study, women with a tubo-ovarian abscess in association with salpingitis did not respond well to antibiotic treatment alone. This may be the most reliable way of distinguishing these patients from women with salpingitis alone or salpingitis in association with a tubo-ovarian inflammatory complex, who, as a group, did respond well to medical management alone.