Pelvic abscess – to drain or not to drain?

Sophie Strong, Stylianos Michail Lazanakis, Elizabeth Ball
In: Current Opinion in Obstetrics & Gynecology · 2023 · vol. 35(5) , pp. 420–425 · doi:10.1097/gco.0000000000000897 · PMID:37266701 · W4379094589
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review examines current literature on pelvic abscess management, identifying factors like size, WBC count, and fertility concerns that may favor early drainage over antibiotics alone.

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Abstract

PURPOSE OF REVIEW: Pelvic abscess is a common gynaecological condition, particularly during and after the Covid-19 pandemic, possibly resulting from obstacles to accessing care during this time. To date, no consensus guideline on management exists with a lack of applicable randomized controlled trials (RCTs) comparing medical management with antibiotics alone, image-guided drainage and surgical management, despite this being a potentially life-threatening condition. RECENT FINDINGS: We present the current literature assessing risks, which contribute to failure of medical therapy, predictive models to guide management and reports of long-term sequelae. Consideration for early laparoscopic or image-guided drainage should be given to women in whom fertility is a priority, pelvic abscess at least 7 cm, white blood cell count on admission more than 16 x 1000/μl, bilateral pelvic abscess, intrauterine device in situ for more than 5.5 years and preexisting endometrioma. Pelvic abscess rupture or severe sepsis should always trigger timely drainage. SUMMARY: We present the current knowledge on management of pelvic abscesses to help guide clinical practice supported by the most recent evidence. We report the lack of high-quality evidence for many aspects of pelvic abscess treatment and call for well designed large multicentre RCTs to answer the question of which treatment yields the best outcomes.

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Condition tags

endometrioma

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References (42)

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last seen: 2026-05-10T11:08:41.280835+00:00
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