Acute kidney injury secondary to bilateral tubo-ovarian abscess: a case report

Tubo-ovarian abscess (TOA) is a severe sequela of pelvic inflammatory disease and is exceedingly rare in postmenopausal women. Acute kidney injury (AKI) is commonly encountered in hospitalized patients; however, AKI due to ureteral obstruction from TOA is exceptionally uncommon. We report a case of a 51-year-old postmenopausal woman with a 27-year retained intrauterine device (IUD) who presented with bilateral TOA and postrenal AKI caused by bilateral hydroureteronephrosis. Initial management included broad-spectrum antibiotics, bilateral nephrostomy, and antegrade double-J stenting. Due to ongoing sepsis and persistent fever, she underwent emergency laparotomy with bilateral abscess drainage and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient’s renal function returned to normal following surgical decompression. This case underscores the importance of considering TOA in the differential diagnosis of postrenal AKI, particularly in women with pelvic masses and signs of infection. Early imaging and multidisciplinary management are essential for favourable outcomes. Retained IUDs in postmenopausal women may contribute to chronic pelvic infections and abscess formation.