Introduction: Tubo-ovarian abscess represents a severe form of pelvic inflammatory disease with high morbidity. Management of tubo-ovarian abscesses is complex and depends on various factors like size of the abscess, condition of the patient and response to antibiotics. Surgical management is not commonly preferred and is reserved for large abscesses and failed medical management.

Case Series: We present a case series of surgically managed patients with tubo-ovarian abscesses. The first case demonstrates a patient who underwent emergency laparoscopy after a long antibiotic course for a misdiagnosed dermoid cyst which turned out to be a chronic tubo-ovarian abscess and had a difficult and long operative procedure due to dense intrapelvic adhesions. Our second patient presented with acute abdomen, sepsis and rapidly deteriorating clinical condition, underwent early laparoscopic intervention within 24hrs suspecting tubo-ovarian abscess rupture and had a rapid recovery after a short operative procedure. The third case demonstrates a chronic tubo-ovarian abscess with dense intrapelvic adhesions in a patient with primary infertility who underwent a difficult laparoscopic surgical intervention for the endometriotic cyst.

Conclusion: Early laparoscopic surgical intervention in abscesses more than 5cm gives a favorable outcome to the patient irrespective of the initial response to antibiotics. Timely laparoscopic intervention in patients is beneficial to avoid prolonged hospitalization, antibiotic usage, and faster recovery. Diagnosis of a tubo-ovarian abscess requires a high degree of suspicion as delay in the diagnosis was the major reason for late surgical intervention.

Keywords: Tubo-ovarian abscess; Failed medical management; Laparoscopy; Surgical intervention