From the Research
There is no established direct link between May-Thurner syndrome and an increased risk of developing tubo-ovarian abscess. May-Thurner syndrome is an anatomical condition where the left iliac vein is compressed by the right iliac artery against the lumbar spine, which can lead to venous stasis and increased risk of deep vein thrombosis in the left lower extremity 1. Tubo-ovarian abscesses, on the other hand, typically develop as a complication of pelvic inflammatory disease (PID), which is usually caused by ascending infection from the lower genital tract 2. The pathophysiology of these two conditions involves different mechanisms - vascular compression in May-Thurner syndrome versus infectious processes in tubo-ovarian abscesses. Some key points to consider in the management of tubo-ovarian abscesses include:
- Diagnosis using transvaginal ultrasound and computed tomography (CT) 2
- Initial medical management with antibiotics, with surgical intervention indicated in those who fail initial medical therapy 2, 3
- The most common microorganisms recovered from tubo-ovarian abscesses are Escherichia coli, Bacteroides fragilis, and aerobic streptococci 3 While patients with May-Thurner syndrome may experience pelvic congestion due to venous outflow obstruction, this vascular phenomenon is not known to increase susceptibility to the bacterial infections that cause tubo-ovarian abscesses. If a patient has both conditions, they should be treated as separate entities with appropriate management for each - anticoagulation and possibly stenting for May-Thurner syndrome 1, 4, and antibiotics (typically broad-spectrum covering anaerobes and gram-negative organisms) for tubo-ovarian abscess, with possible surgical drainage if indicated.