Ameneh Haghgoo - MD, OB GYN, Advanced laparoscopy fellowship, Nikan Hospital, Tehran, Iran
Mehran Ghahremani - MD Pathologist Pars Hospital Research Center
Maryam Almasi Nasrabadi - MD, OB GYN, Laparoscopy Fellowship, Ebnesina Hospital, Tehran, Iran

Background and Aim : Women suffering from stage III-IV endometriosis are much more likely to developtubo-ovarian abscesses than those without endometriosis. Although the presentations of TOA can bevariable, the abscess classically manifests with fever, elevated inflammatory markers, an adnexal mass,lower abdominal-pelvic pain, vaginal discharge, and even peritonitis-related symptoms. Our study wasconducted to evaluate the prevalence of TOA and related findings among patients who underwentlaparoscopy surgery due to severe endometriosis.Methods : The present observational study was conducted on all patients with severe endometriosis (stageIII and IV) referring to a private gynecology clinic and underwent laparoscopy surgery between 2018 and2019. All surgeries were performed by the same surgeon (Dr. A Haghgoo) in Nikan hospital (Tehran, Iran).We registered all TOA cases during the study period and microbial culture was performed in all TOA cases(samples were collected using cotton swab).Results : Totally 370 patients with severe endometriosis (stage III and IV) were assessed in this study andunderwent laparoscopy surgery. The mean age of the participants was 36.47 years. We found 38 (10.27%)patients with TOA and pus discharge from the extraction site. Only four patients with TOA (7.9%) hadpositive microbial culture results. Among TOA cases in our study, one patient reported vaginal dischargebefore the surgery, three participants had fever and the other women reported unspecific symptomsincluding dysmenorrhea, dyspareunia, pelvic pain, and pelvic mass. nine patients (23.7%) had no historyof previous surgery but one of them was immunocompromised due to SLE, and 11 women (28.9%) reporteda history of laparotomy or laparoscopy during the last year. Four (10.5%) participants had experiencedendometrial curettage or hysteroscopy before the current surgery and 10 women (26.3%) had a history ofIVF, and 3 patients reported multiple types of abdominal surgery during the last year before recent surgery.Conclusion : In our study, we found TOA in endometriosis patients with any paraclinical findings andlimited and unspecific clinical findings. In addition to the considerable prevalence of TOA in our study, the lack of clinical and paraclinical findings among these patients, specially in comparison to the TOA patientswithout endometriosis, draws attention to the importance of diagnostic interventions.

Endometriosis tubo-ovarian abscesses-IVF-ART-Endometrioma