Tubo-ovarian abscess (TOA) refers to a potentially life-threatening collection of infection located in the fallopian tubes or peritoneal cavity. It is mostly a later sequela of pelvic inflammatory disease (PID) but can arise in the absence of prior sexually transmitted infection.

Etiology for TOA development following a sexually transmitted infection involves ascending spread of disease to the level of the fallopian tubes / peritoneal cavity. Risk factors include having unprotected intercourse, multiple sexual partners, and a history of prior PID. Intrauterine devices (IUDs) have not been found to be a risk factor for TOA development.

The typical age range includes reproductive aged women. The US Centers for Disease Control and Prevention (CDC) reports that approximately 2.3% of patients with PID will proceed to a TOA. Patients with human immunodeficiency virus (HIV) are more likely to develop a TOA. Postmenopausal patients with TOAs need special consideration, as there is a high rate of malignancy associated with TOAs in this age group.

Patients will present with lower abdominal pain, often with fever and possibly with sepsis. Other symptoms may include nausea / vomiting, pain with intercourse, and vaginal discharge.

Physical examination will be positive for abdominal and/or adnexal tenderness and potentially show cervical motion tenderness as well. A pelvic mass will present on imaging.

Rupture is a surgical emergency. Symptoms of TOA rupture include signs of sepsis (hypotension, tachycardia, tachypnea) as well as an acute abdominal examination (rebound / guarding). Reported rate of rupture is approximately 15%.