Laparoendoscopic Single-Site Surgery for Management of Tubo-Ovarian Abscess After Hymenectomy for Imperforate Hymen

Abstract

Background: A tubo-ovarian abscess is a potential late complication after hymenectomy for imperforate hymen, especially when complicated with hematosalpinx. Laparoendoscopic single-site (LESS) surgery for management of tubo-ovarian abscess after hymenectomy has never been reported. Case: A 17-year-old virgin girl without a menarchal flow was referred due to a large pelvic cystic mass. With a diagnosis of an imperforate hymen with right hematosalpinx, an uneventful hymenectomy was performed for this patient. Six weeks later, she presented with lower-abdominal pain and febrile morbidity. Results: Antibiotics administration was initiated with the diagnosis of a right tubo-ovarian abscess. After failed medical management, LESS surgery was performed. Under laparoscopic observation, a severe pelvic adhesion around swollen right adnexal tissue was noted. After extensive adhesiolysis, a right salpingo-oophorectomy was performed, and the patient's postoperative course was uneventful. Conclusions: After hymenectomy for imperforate hymen with hematosalpinx, careful follow-up should be done to detect any secondary ascending pelvic infection leading to a tubo-ovarian abscess. LESS surgery may be a feasible minimally invasive option for managing a tubo-ovarian abscess with potential cosmetic benefits.