Bilateral Tubo-Ovarian Abscesses Four Years After Total Abdominal Hysterectomy

L E Mendez,I R Horowitz,S M Bhoola

doi:10.1155/s106474499800026x

Abstract

Background: Pelvic inflammatory disease (PID) is a common gynecologic disorder. One known complication of PID is tubo-ovarian abscess (TOA) formation. The predominant theory on TOA formation postulates that an ascending infection from the cervix through the uterus to the fallopian tubes and ovaries results in abscess formation. Other theories include seeding via a hematogenous infection, diverticular disease, and appendicitis.Case: A 39-year-old female patient with abdominal pain was referred to our institution and was found to have a pelvic mass. After a thorough evaluation, surgical exploration revealed the presence of TOA. No evidence of gastrointestinal disease was present. The patient’s history was significant for an uncomplicated total abdominal hysterectomy for benign disease of the uterus four years prior. Abscess cultures grew Streptococcus intermedius.Conclusion: This case reports the rare occurrence of TOA in a patient who had undergone an abdominal hysterectomy four years prior to presentation. If the patient reports a surgical history of prior hysterectomy, TOA is often stricken from consideration. Although unlikely, adnexal abscess formation should be considered in the differential diagnosis of a patient with abdominal pain and a pelvic mass, even with a remote history of hysterectomy.

Highlights

Pelvic inflammatory disease (PID) is a common gynecologic disorder
This case reports the rare occurrence of tubo-ovarian abscess (TOA) in a patient who had undergone an abdominal hysterectomy four years prior to presentation
If the patient reports a surgical history of prior hysterectomy, TOA is often stricken from consideration

Summary

Conclusion

This case reports the rare occurrence of TOA in a patient who had undergone an abdominal hysterectomy four years prior to presentation. Adnexal abscess formation should be considered in the differential diagnosis of a patient with abdominal pain and a pelvic mass, even with a remote history of hysterectomy. Her medical history revealed no contributory information Significant events in her surgical history were cesarean delivery in 1978, a bilateral tubal ligation in 1980, and a total abdominal hysterectomy for a leiomyomatous uterus four years prior to the current event. She had not experienced any infection or fever. On that day a repeat white blood cell count was 20,400/mL, and the patient’s symptoms were not improving Her abdominal pain was persistent, and the finding of bilateral pelvic masses was worrisome. Final blood and aerobic abscess cultures were negative; anaerobic abscess culture grew Streptococcus intermeall//.7

DISCUSSION

Findings

Droegemueller W