To identify the epidemiologic and clinical risk factors associated with failed response to medical treatment in tuboovarian abscess (TOA) patients and whether there is a relationship between the presence of intrauterine device (IUD), duration of use and medical treatment success or not.

For this study, the medical records of patients diagnosed with TOA and hospitalized in an 8-year period were analyzed retrospectively. The presence of TOA and IUD was confirmed ultrasonographically in all patients. Parenteral antibiotic treatment was initiated as the first step. Patients who did not improve with this medical treatment underwent surgery. Patients who recovered with medical treatment were defined as the successful group, while those who underwent surgery after medical treatment failure were recorded as the failed group.

There were 37 patients in successful group and 87 patients in failed group. The mean age, parity, white blood count, TOA size, duration of IUD use, rate of multigravida and multiparity were higher in the failed group. Logistic regression analysis revealed that presence of multiparity, TOA size and the duration of IUD use were significant independent factors in predicting medical treatment success of TOA. The best cut-off value for TOA size was 4.5 cm and for duration of IUD use was 5.5 years in the Receiver Operating Characteristic curve analysis.

The presence of long-term IUD use, increased TOA size, and multiparity were found to be risk factors related to the failure of medical treatment in TOA cases.