Tubo-Ovarian Abscess Following Perforated Appendicitis in an Adolescent

Abstract

Background: Appendicitis is the most common cause of emergency abdominal surgery in children. Delay in diagnosis correlates strongly with the rate of perforation. Common complications of perforated appendicitis include wound infection, intra-abdominal abscess, and prolonged ileus. Other rare complications include pleural effusion, urinary tract infection, urinary retention, bleeding, wound dehiscence, pneumonia, and intestinal obstruction. The proximity of the fallopian tubes to the appendix and the peristaltic nature of the tube make it reasonable to believe that there would be a risk of tubo-ovarian abscess (TOA) following perforation of the appendix. Case: A 17-year-old, non–sexually active female presented to the emergency department with acute appendicitis. She underwent laparoscopic appendectomy, which revealed perforation of the appendix. Her postoperative course was complicated by persistent abdominal pain, fever, and leukocytosis. She was later found to have bilateral TOA. She was treated with antibiotic therapy, with resolution of symptoms. The prevention, diagnosis, and treatment of TOA resulting from perforated appendicitis are discussed. Conclusions: In female patients with persistent postoperative abdominal pain, fever, and leukocytosis following appendectomy for perforated appendicitis, the possibility of TOA should be considered. (J GYNECOL SURG 27:37)