Abstract
We report herein a 41-year-old female with a tubo-ovarian abscess (TOA), which microbial cultures showed to contain extended-spectrum beta-lactamase (ESBL)-producing E. coli, a causative agent of community-acquired infection. The patient initially presented with acute abdominal pain and back pain. Pelvic computed tomography and transvaginal ultrasonography revealed multiple cystic lesions in the bilateral ovaries that suggested TOA. An emergency laparotomy was therefore performed due to the potential for life-threatening septic shock from the TOA-associated pelvic inflammatory disease. Microbial cultures of postoperative fluid discharge from the placed intra-abdominal catheter, vaginal secretions, urine, blood, and feces detected ESBL-producing E.coli. In summary, we successfully performed emergency surgery for life-threatening septic TOA caused by ESBL-producing E. coli infection.
Highlights
A tubo-ovarian abscess (TOA) can develop in reproductive age women with pelvic inflammatory disease (PID)
TOA is most frequently induced by ascending infection through the uterus due to Neisseria, gonorrhoeae, Chlamydia, E. coli, or indigenous bacteria of the vagina and cervix, and it usually follows PID [1, 2]
extended-spectrum beta-lactamase (ESBL)-producing bacteria is well known as one of the multiple-antibiotic-resistant bacterium identified by German Knothe in 1983 [13]
Summary
A tubo-ovarian abscess (TOA) can develop in reproductive age women with pelvic inflammatory disease (PID). She was initially diagnosed with a urinary tract infection and received systemic antibiotic therapy for 2 days She complained of worsening abdominal pain and high fever, suggesting PID due to bacterial infection into the bilateral ovaries, and was subsequently referred to our hospital. The patient suffered further abscess formation due to infection of the postoperative hematoma in the pelvic cavity, and underwent a repeat laparotomy with abdominal drainage for diffuse peritonitis 12 days after the initial surgery. She subsequently suffered intra-abdominal septic complications, and underwent ultrasound-guided percutaneous drainage on the 27th postoperative day. She made a favorable recovery and was discharged from our hospital 72 days after the first emergency surgery
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