OB GYN

Question 1

Management of sigmoid obstruction due to endometriosis

Answer 1

Resect because later strictures will form even if medication causes regression in endometriosis

Question 2

Management of tubo-ovarian abscess

Answer 2

If less than 5 cm just antibiotics!

If you have gone in for appendectomy do the appendectomy

Rupture of a TOA occurs in approximately 15 percent of cases. Women suspected of having a ruptured TOA or who present with signs of sepsis require immediate surgical exploration. Laparotomy appears to be the best route in these emergent cases. (See ‘Abscess rupture’ above and ‘Surgery’ above.)

We suggest treatment with antibiotic therapy alone for women who meet the following criteria: hemodynamically stable with no signs of a ruptured TOA; abscess

Question 3

ovarian cyst

Answer 3

If the patient has been asymptomatic with a small functional cyst, observation, especially for the younger patient, is most appropriate. If the functional ovarian cyst is large (>5 to 6 cm) or symptomatic, aspiration may be considered.

If the cyst is larger or is not consistent with a functional lesion, oophorectomy may be considered if the patient is closer to menopause.

As an alternative, ovarian cystectomy may be considered. This option removes the cyst but preserves the function of the ovary. It also reduces the risk for recurrence as compared with ovarian cyst drainage.