The rupture of a tubo-ovarian abscess may be associated with pneumoperitoneum as well as peritonitis.
Clinical presentation may include:
(1) abdominal pain
(2) nausea and vomiting
(3) peritoneal signs
(4) variable adnexal mass
(5) fever
While tubo-ovarian abscess is most common in young women with pelvic inflammatory disease (PID), it can occur at other ages and for other reasons. It may not be considered if PID is not suspected.
A key differential diagnosis is a perforation of the gastrointestinal tract. Concern for a bowel perforation may prompt emergency laparotomy or laparoscopy.
Imaging studies may demonstrate a tubo-ovarian mass or cysts with pelvic adhesions. If the abscess has deflated then changes may be more obscure.
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