Ovarian Abscess Research Articles

Penetration of Sigmoid Colon Diverticulitis to the Left Uterine Adnexa Causing Ovarian Abscess Concomitantly—Report of a Case—

Penetration of Sigmoid Colon Diverticulitis to the Left Uterine Adnexa Causing Ovarian Abscess Concomitantly—Report of a Case—

Detection of Relationship between Female Infertility and Pelvic Inflammatory Disease at Zagazig University Hospitals

Infertility is a 2-year inability to conceive following routine unprotected sexual activity in the absence of established reproductive pathology. PID is typically the result of endocervical infection that triggers endometritis, salpingitis, parametritis, oophoritis, ovarian abscess and pelvic periotinitis. Delays of just a few days in reciving adequate treatment particularly in Chlamydia infections significantly increase the risk of infertility. The purpose of the present study was to detect female infertility early among 191 women with infertility complaining from pelvic inflammatory disease selected from the Outpatient Clinics of Gynecology and Obstetric Department, Zagazig University Hospitals.Patients and methodsAll women were subjected to full history taking. General, abdominal and local examinations were done to all women for the presence of any cervical lesions. Positive result supported the diagnosis of PID, if available with the patient from the past.ResultsThe age of the studied group ranged from 17 to 36 years, husband age ranged from 18 to 42, 68.1% of the case group had PID, 60.2% of them had married from 1 to 5 years, 75.4% were housewives, 81.2% were non-educated, 55.5% were nulliparous, 69.2% were rural resident and 67.1% were of high social class. There was statistically significant differences between positive and negative PID patients regarding parity, social class, methods of contraception, reported history of PID, hospitalization due to PID, WBCs and using IUD as contraception. ConclusionThere was a strong relation between infertility and pelvic inflammatory disease.

Endometrioma ethanol sclerotherapy could increase IVF live birth rate in women with moderate-severe endometriosis.

To examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis. This retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate. Seventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13-6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage. EST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women.

ASSESSMENT OF SUSPICIOUS OVARIAN MASSES BY COMPARATIVE STUDY OF USG AND CT TECHNIQUES

Undoubtedly, most ovarian lesions, endometrial pathology and uterine lesions are best detected with ultrasound. Computed tomography (CT) imaging offers better diagnostic capabilities for large pelvic masses, tubo- ovarian abscesses, postoperative and postpartum complications. In some cases, Computed Tomography (CT) is employed to achieve optimal differential Diagnosis to determine the clinical pathway to follow. Hence based on above findings the present study was planned for Assessment of Suspicious Ovarian Masses by Comparative Study of USG and CT Techniques.
 The present study was planned in Department of Radio- Diagnosis, Katihar Medical College, Katihar (Al-Karim University), Bihar, India. In the present study 50 females were enrolled having Suspicious Ovarian Masses. Computed tomography (CT) and USG characteristics of different lesions were noted and recorded. The histopathological diagnosis was followed up and recorded. The results of this study were analysed and compared with other available studies in literature.
 The data generated from the present study concludes that Ultrasonography is usually the first imaging modality in evaluation of female patients suspected to have pelvic pathology. Computed tomography is superior diagnostic imaging modality than USG prior to treatment which improved detection and characterization of tumour due to better diagnostic accuracy and consequently reduction of invasive procedure which lead to significant reduction of mortality and morbidity from tumour.
 Keywords: Ovarian Masses, Comparative Study, USG, CT Techniques, etc.

A Massive Primary Ovarian Abscess within an Endometrioma in a Young Nullipara – An Unusual Case and Review of Literature

Primary ovarian abscess without the involvement of the fallopian tube is a rare complication of an underlying endometrioma. Surgical interventions like ultrasound guided oocyte retrieval in in vitro fertilization and endometrioma aspiration may be a possible source of infection. De novo primary ovarian abscess within an endometrioma in the absence of a risk factor is even rarer. Decreased natural killer cell activity leads to a failure to clear out the ectopic endometrial tissue and the collected blood acts as a potential culture medium for the growth of pathogenic microorganisms. Infected ovarian endometrioma is a surgical emergency and preserving the fertility in a nullipara is a challenge. We report an unusual case of a massive de novo ovarian abscess masking an endometrioma in a young nulliparous woman with no risk factors. We have summarized current literature and evaluated the etiopathogenesis and the risk factors leading to abscess formation within an endometrioma.

95. Cyclic Fevers with Menses from Salmonella Ovarian Abscess

95. Cyclic Fevers with Menses from Salmonella Ovarian Abscess

Ovarian Abscess: A Rare but Serious Complication of Transvaginal Oocyte Retrieval for IVF - A Case Report

Ovarian Abscess: A Rare but Serious Complication of Transvaginal Oocyte Retrieval for IVF - A Case Report

Colo-ovarian Fistula complicating acute diverticulitis: Two cases and literature review

IntroductionColonic diverticulosis is common in western world. Fistula formation occurs in 10–20 % of patients, usually as a consequence of an acute inflammatory process (diverticulitis). Fistulas from diverticulitis occur mainly to bladder, small bowel and uterus. Communication between colon and ovary occurred more frequently in the context of primary neoplasms of ovary, ovarian abscess or Crohn’s disease. However, colo-ovarian fistula after acute colonic diverticulitis is a rare entity with few cases reported in literature. Presentation of casesIn this article, we described two cases. We also performed a literature review. In both cases, an initial conservative management for acute diverticulitis was performed. The maintenance of symptoms dictated further investigation. The presence of left ovarian abscess was presented, suggesting the presence of fistula. DiscussionAlthough the distinct evolution during the initial treatment, which results in different timing for surgery, en bloc resection of colon and adnexa was performed, with favorable outcomes. Final pathological analysis confirmed the diagnosis. ConclusionColo-ovarian fistulas complicating acute diverticulitis are rare entities. In this article, we present our experience in the management of two cases, with different surgical approach but favorable outcomes.

Salmonella Ovarian Abscess in a Patient with Systemic Lupus Erytematosus Presented as Acute Abdomen: A Case Report and Review of the Literature

Salmonella Ovarian Abscess in a Patient with Systemic Lupus Erytematosus Presented as Acute Abdomen: A Case Report and Review of the Literature

Ovarian actinomycosis mimicking ovarian malignant tumor with no history of intra-uterine device: a rare case

Background: Pelvic actinomycosis constitutes 3% of all human actinomycosis infections, and is mostly associated with an intrauterine device (IUD). Ovarian actinomycosis with no history of IUD is very rare. Case Report: A 61-year-old female presented with ovarian actinomycosis mimicking ovarian malignant tumor. The present was a very rare case of ovarian actinomycosis with no history of IUD. The patient presented with abdominal pain and mild fever for a half year. On examination, bilateral ovarian tumors suspecting ovarian malignant tumor were detected. At the operation, the authors diagnosed the patient as bilateral ovarian abscess and performed a bilateral ovarian cystectomy. The pathological examination of bilateral ovary showed ovarian abscess, and immunohistochemistry of bilateral ovary showed ovarian actinomycosis. The diagnosis was established postoperatively. Conclusion: Although diagnosis of ovarian actinomycosis is very difficult, especially in patients with no history of IUD, ovarian actinomycosis should be considered in case of suspecting ovarian malignant tumor with abdominal pain and fever persisting for a long interval.

MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome

This study aims to explore how Herlyn–Werner–Wunderlich Syndrome (HWWS) manifests in diagnostic images and analyze the imaging specifications and differential diagnoses thus improving the understanding of the disease. The preoperative magnetic resonance imaging (MRI) findings and clinical data of 19 patients with HWWS were retrospectively analyzed, taking the intraoperative findings and postoperative pathological results of laparoscopic or hysteroscopy surgery as the diagnostic criteria. In this study, all the 19 patients underwent laparoscopic or hysteroscopic excision of vaginal oblique septum, and the preoperative MRI diagnosis of HWSS was consistent with the clinical postoperative diagnosis, with a diagnosis coincidence rate of 19/19 (100%). According to the classification of vaginal oblique septum syndrome, 16 cases were vaginal oblique septum type I and 3 cases were vaginal oblique septum type II. MRI showed a double uterus and double cervix, blood accumulation and dilatation of the vagina connected with the cervix of the affected side, T1WI showed high signal intensity and T2WI showed low or mixed signal intensity. MRI coronal view of 19 patients clearly showed ipsilateral renal absence with obstruction, including 5 cases on the left and 14 cases on the right. Other pelvic complications included: 1 patient with cervical dysplasia and the absence of right kidney and ureter, 3 patients with right ovarian endometriosis cyst, 1 patient with complicated with adenomyosis, 1 patient with right ovarian follicular cyst, 1 patient with right ovarian fallopian tube and pelvic abscess, and 1 patient with right ovarian hematoma. The MRI image of HWWS has its own features and MRI can more accurately evaluate type and related complications of HWWS, therefore it can be used as the best and effective examination method for preoperative imaging evaluation, thus better providing help for clinical comprehensive preoperative evaluation and guidance of surgery.

2469 Perforated Copper-T Causing an Ovarian Abscess: The First Reported Case

Video Objective To demonstrate laparoscopic retrieval of a rare case of Copper-T migration causing ovarian abscess. Setting A 34 year old Para4 Living4, who underwent a seemingly uneventful Copper-T insertion. She presented at follow up with lower abdominal pain for two months, and fever. Ultrasound showed an empty uterine cavity with Copper-T seen in the right adnexal region. Interventions She underwent laparoscopy proceed. At laparoscopy, the Copper-T was found to be embedded in a right tubo-ovarian mass which was adherent to the pelvic side wall. Ovary was friable, with abscess draining ∼5cc of purulent fluid. The Copper-T was dissected free of the T-O mass. Ureter was dissected free, and integrity ensured. Bilateral salpingectomy and thorough lavage was done. Patient was covered with broad spectrum antibiotics. Post-operative period was uneventful. Conclusion Perforation and migration of IUD can rarely lead to ovarian abscess. Diagnosis and retrieval should be prompt, with appropriate antibiotic cover. Laparoscopic retrieval is a feasible method for IUD retrieval. In-depth knowledge of laparoscopic surgical anatomy is essential in such cases.

1498 A Rare Case of an Atypical Mass Involving the Sigmoid Colon

INTRODUCTION: The etiology of colonic masses is broad including benign polyps, primary adenocarcinoma, metastases, and diverticular mass. Presentation may be similar; therefore, the differentiation generally involves biopsy for histological evaluation and appropriate diagnosis. CASE DESCRIPTION/METHODS: A 34-year-old female presented with hematochezia and constipation. Her past medical history was significant for tubo-ovarian ovarian abscesses (TOAs), endometriosis fibroids and schwannoma of the paraspinal area. She reported new onset red blood per rectum, worsening constipation, and pelvic discomfort. Family history was notable for esophageal and colorectal cancer. She subsequently underwent colonoscopy which demonstrated a 3-4 cm nodular, polypoid fungating mass in the distal sigmoid colon located at 20-25 cm from the anal verge (Figure 1). Biopsies were obtained and the site was tattooed. A subsequent MRI of the abdomen and pelvis showed a heterogeneous inflammatory soft tissue encasing the ovaries and tethering the rectosigmoid colon (Figure 2). Additionally, there was a enhancing soft tissue mass invading the inferior wall of the distal sigmoid colon with an intraluminal component. The MRI findings were felt to be consistent with invasive endometriosis. Histological examination of the sigmoid mass showed colonic mucosa with polypoid endometriosis without evidence of malignancy (Figure 3). Cells showed positive immunohistochemical staining consistent with endometriosis. Surgical resection was recommended. DISCUSSION: This case demonstrates the importance of having a high suspicion of endometriosis involving the bowel in reproductive age women presenting with abdominal pain, dysmenorrhea, dyspareunia, and dyschezia. Endometriosis is a condition involving the implantation of endometrial stroma and glands at extra-uterine sites. Endometriosis tends to involve bowel serosa. It rarely encompasses full thickness of the bowel wall. The latter represents invasive endometriosis. Many patients are incorrectly diagnosed given their presentation. This disease increases risk of gastrointestinal tumors, primarily adenocarcinoma. Therefore, prompt recognition and treatment with hormonal therapy or surgical excision is important for symptom relief, increase in fertility, and later complications such as bowel stenosis, hydronephrosis, and malignant transformation.

Ovarian abscess caused by Salmonella enterica serovar Typhi: a case report

BackgroundTyphoid fever is a human-specific disease caused by a bacterium, Salmonella enterica subspecies enterica serovar Typhi. It is transmitted through ingestion of contaminated food or water. It is mostly diagnosed by blood culture. Salmonella Typhi usually manifests as a febrile illness with bacteremia after initial entry through the gastrointestinal route, but it can occasionally cause significant disease in extraintestinal sites. We report a case of a girl in Fiji with a right ovarian abscess infected by Salmonella Typhi.Case presentationA 14-year-old iTaukei (indigenous Fijian) girl presented to our hospital with abdominal pain of 1 month’s duration. Two days prior to her admission, she developed high-grade fever and nausea and had one episode of vomiting. On presentation, she appeared unwell; she was tachycardic (116 beats per minute) and febrile (38.8 °C). Her abdominal examination revealed generalized tenderness. Other examination findings were normal. The provisional diagnosis of abdominal sepsis led to an emergency laparotomy during which an enlarged right ovary was found to be spontaneously discharging pus. The ovary was incised and drained, and the patient was commenced on intravenous ceftriaxone 1 g twice daily, cloxacillin 1 g four times daily, and metronidazole 500 mg three times daily. She recovered promptly and was discharged to home on the sixth postoperative day. The purulent material from the ovary grew Salmonella Typhi.ConclusionExtraintestinal infections caused by Salmonella Typhi are rare but can cause severe and life-threatening disease. Our patient had a prolonged history of abdominal pain and was found to have a ruptured right ovarian abscess due to Salmonella Typhi. Ovarian abscesses in girls who are not sexually active are not associated with pelvic inflammatory disease and suggest local or hematogenous spread. This case report may increase health workers awareness to include common and endemic infections in the differential diagnosis of unusual clinical presentations to help the initiation of appropriate investigation and management as quickly as possible.

Xanthogranulomatous Salpingitis.

There are approximately a dozen cases of xanthogranulomatous salpingitis reported in the literature, mostly as case reports. Thirteen such cases were identified from 2003 to 2018 at our institution. Patient's ages ranged from 21 to 75 yr old (median and mean, 49 yr). Clinical presentations and surgical indications included pelvic inflammatory disease (5 cases), endometrial carcinoma (4 cases), suspicion of ovarian malignancy (1 case), symptomatic fibroids (1 case), endometriosis (1 case), and infertility (1 case). Surgical-pathologic correlation resulted in diagnoses of tubo-ovarian abscess (4 cases), ovarian abscess (2 cases), pyosalpinx (2 cases), and chronic endometritis (2 cases). Of the remaining 3 cases, 2 presented clinically as pelvic inflammatory disease and the other was seen in the context of an endometrial carcinoma. In summary, this case series from a single institution shows that xanthogranulomatous salpingitis is an uncommon form of chronic inflammation that may be diagnosed from reproductive to menopausal age. With one exception, the cases in this series represent pelvic inflammatory disease despite variable clinical presentations. Pseudoxanthomatous salpingitis should be in the differential diagnosis.

Salmonella enteridis ovarian abscess in a 10-year-old patient in New Caledonia - Case report and review of the literature

Salmonella ovarian abscesses are rare especially in pre-pubertal patients. We report a case of Salmonella enteridis ovarian abscess in a 10-year-old patient with no medical history who had a favorable outcome after surgical management and effective antibiotic therapy. The challenge in our clinical case was to preserve the ovarian reserve of our patient so as not to cause long-term fertility issues. The review of the literature has allowed us to highlight other cases of Salmonella ovarian abscesses, particularly those causes by Salmonella typhi. Most patients were of childbearing age, and generally presented with an underlying pathology (gastro-intestinal, auto-immune) that may have promoted opportunistic pelvic infections. Alternatively, there was often a preexisting ovarian pathology such as: ovarian cyst, endometrioma, teratoma, or dermoid cyst.

Proton MR spectroscopy and the detection of malignancy in ovarian masses.

To assess the impact of MR spectroscopy (MRS) on the detection of malignancy in ovarian masses. This prospective work included 230 females that had 245 adnexal/ovarian masses. Tumours were spotted by preliminary pelvic ultrasound. Masses assessed by MRI, multi- or single-voxel spectroscopy. Patients' spectra were assessed for peaks of lactate (Lac, 1.31 ppm), lipid (Lip, 1.33 ppm), N-acetyl aspartate (2.0 ppm), acetone (A, 2.05 ppm), choline (Cho, 3.23 ppm) and creatinine (Cr, 3.4 ppm) and the mean values of the (Cho/Cr) ratios were performed by a semi-quantitative approach. The operative pathology served as the standard of reference. Cho peak twofold higher than the average noise level was detected in 72% of the malignant and only 5.4% of the benign masses with an accuracy of 83%. Adding lactate to the choline enhanced the accuracy to 93%. The mean Cho/Cr ratios of the malignant ovarian masses (2.8) were significantly higher than that of the benign ones (1.2) . We used a receiver operating characteristic curve to determine the best cut-off value (1.7) for the mean Cho/Cr ratio to discriminate malignancy with sensitivity: 81.2%, specificity: 93.3 %, positive-predictive value: 92.9 %, negative-predictive value: 82.4% and accuracy: 87.1%. The simultaneous presence of choline and lactate peaks in MRS examination of the ovarian masses minimizes the overlap between benign and malignant categories. N-acetyl aspartate and acetone are the metabolites for diagnosing complex cystic masses as benign teratoma, endomterioma and tubo- ovarian abscess. MRS is a non-contrast based and fast MR sequence that gives an idea about tissue components could be used to improve the sensitivity and the accuracy of detecting malignancy in ovarian masses.

Review of pelvic masses aspirated under ultrasound guidance

Objective The purpose of the study was to assess the utility and importance of ultrasound-guided aspiration of pelvic masses and to review our experience. Method 186 cases of pelvic masses were referred to our Ultrasound Clinic in Karachi from February 2008 to December 2018. Based on Ultrasound criteria, diagnosis of cysts, abscesses, endometriomas and pelvic collections were made. Diagnostic/ therapeutic aspirations were carried out. Masses were aspirated per-abdominally by free-hand technique whereas endovaginal aspirations were done via puncture adapter technique. 14-18 gauge needles were used based on the viscosity of the fluid as determined by the zone of enhancement. All patients were reassessed after 15 days to evaluate any pain, discomfort, spill or recurrence. Result After meeting the selection criteria, 186 cases of pelvic masses were aspirated. Out of them, 18 turned out to be ovarian abscesses whilst 120 were chocolate cysts (endometriomas). 7 peritoneal abscesses and 4 psoas abscesses were also drained. 28 were found to be ovarian cysts with clear transparent fluid and 9 were found to be ovarian cysts with a tinge of red or dark yellow fluid. On follow-up, recurrance was observed in 28 patients (18.8%), 8 patients (5.4%) complained of mild pain and slight discomfort right after the procedure which was relieved by Panadol. No fluid collection was seen in the cul de sac Conclusion Ultraound-guided aspiration of pelvic masses is a relatively safe, simple and cost-effective alternative to more invasive methods such as laproscopy and laparotomy. The paper will highlight the sonographic features of different cystic masses with special reference to ovarian abscesses versus endometriomas.

Benign ovarian lesions with restricted diffusion.

Developments in magnetic resonance imaging have expanded its role in the assessment of the female pelvis, including the diagnosis of ovarian lesions. In this setting, diffusion-weighted imaging has proven its diagnostic value, which is particularly important in differentiating between benign and malignant ovarian tumors. In general, the latter show restricted diffusion, whereas the former do not. Exceptions include teratomas, endometriomas, hemorrhagic cysts, ovarian abscesses, ovarian infarction, and some benign stromal tumors. The aim of this review is to draw attention to benign ovarian lesions with restricted diffusion, with a special focus on diffusion-weighted imaging pearls and pitfalls.

输卵管卵巢脓肿的诊治现状

输卵管卵巢脓肿的诊治现状