Medical therapy often cures tuboovarian abscess. (Preserves Future Fertility).

LAKE TAHOE, NEV. -- Tuboovarian abscess responds to medical therapy about 70% of the time, Dr. Clara Paik said at an obstetrics and gynecology conference sponsored by the University of California, Davis.

Historically, management included a hysterectomy and bilateral salpingo-oophorectomy, but this approach destroys future fertility and induces menopause. It also resulted in an 8% rate of bowel injury in one study, said Dr. Paik of the department of obstetrics and gynecology at the university's hospital in Sacramento.

A tuboovarian abscess (TOA) develops as a result of pelvic inflammatory disease (PID) when the fallopian tube becomes inflamed. This leads to production of a purulent exudate, which can lead to pelvic peritonitis. If the fimbriated end of the tube becomes blocked, acute pyosalpinx can result.

The tubal serosa may also become inflamed, causing adherence to adjacent surfaces of the ovary, omentum, sigmoid, small bowel, broad ligament, and cecum.

The phenomenon is a common complication of PID, occurring in 15%-30% of hospitalized cases, most commonly in women in their 20s and 30s. Pelvic pain is the most frequent presenting complaint, occurring in more than 90% of patients with TOA.

"The clinical findings are very similar to patients with PID, although it is important to recognize the presence of an adnexal mass," she said.

Sixty to 80% of TOA patients will have a fever greater than 100[degrees] F and leukocytosis, however, "a surprising number" will also be afebrile and have a normal white blood cell count, she warned.