ABSTRACT
Although laparoscopy is considered the gold standard for the diagnosis of PID, the diagnosis is most often made clinically without laparoscopy. Treatment of PID is almost always medical. Surgical treatment is infrequent and done usually only in occasional cases of tubo-ovarian abscess (TOA). When PID is complicated by TOA and medical treatment is insufficient, drainage of the TOA may be necessary. This can be done nonsurgically by placement of a transvaginal or percutaneous drain using ultrasound guidance (133-135). Surgical treatment may be via laparoscopy, laparotomy, or colpotomy. Because laparoscopy and colpotomy are less invasive than laparotomy and appear to give similar outcomes when conservative surgery is performed, they are the preferred approaches (136-138). In some life-threatening cases of TOA, hysterectomy and salpingo-oophorectomy may be necessary.
