Laparoscopic Resection of An Extensive Tuboovarian Abscess in A Mechanical Valve Replacement Woman

Phornsawan Wasinghon,Kuan-Gen Huang

doi:10.21613/gorm.2018.858

Abstract

The case is a 44-year-old-female who presented with right lower abdominal pain without fever or leukocytosis. She had previous mechanical valve replacement with taking warfarin for last ten months from the diagnoses of infective endocarditis. The ultrasonography showed bilateral complex ovarian mass. At laparoscopy, the patient had a right tubo-ovarian abscess and a left mature teratoma with extensive adhesions to the rectum. A case illustrates an uncommon premenopausal age with right tuboovarian abscess and left mature teratoma. The laparoscopic surgery is an excellent benefit for quicker recovery time, smaller incisions, less post-operative pain, and especially of a few infections that will affect to underlying disease of the patient.

Highlights

Pelvic inflammatory disease (PID) is a prevalent medical problem among reproductive age and menopausal women
It has been reported that 34% of patients who were initially diagnosed with PID had an occurrence of tuboovarian abscess [1,2,3] in which the tuboovarian abscess patients were asymptomatic surgically confirmed with 35% of patients being afebrile, and 23% had an average white blood cell (WBC)
This study presented the case of a patient with afebrile chronic pelvic pain and the bilateral ovarian masses, who had an underlying mechanical valve replacement and used warfarin

Summary

Introduction

Pelvic inflammatory disease (PID) is a prevalent medical problem among reproductive age and menopausal women. This study presented the case of a patient with afebrile chronic pelvic pain and the bilateral ovarian masses, who had an underlying mechanical valve replacement and used warfarin. A 44-year-old-female, who had three cesarean deliveries, sustained underlying hypertension (HT) She had a chest wall scar from infective endocarditis where the mechanical valve had been replaced since August 2017 she was prescribed warfarin. The histopathology showed the abscess formation at the right ovary and the mature teratoma at the left ovary. This case is the high risk for surgery in a patient who coexists with the high risk of infection from the tuboovarian abscess and the extensive adherent adhesion at Chang Gung Memorial Hospital.

Discussion

Findings

Conclusions