A tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease (PID) resulting from an ascending infection of the upper genital tract. It is characterized by an inflammatory mass involving the fallopian tube, ovary, and sometimes adjacent pelvic organs. It is diagnosed through clinical evaluation and imaging, and initially treated with broad-spectrum antibiotics. Despite conservative management, surgical intervention may be necessary if there is a leak or rupture of the TOA or if the patient experiences chronic pain. Rarely, a TOA can cause septicemia. Insertion of an IUD in a patient with a history of PID is contraindicated. A 41-year-old, gravida 2, para 1011 (G2P1011) woman presented with a TOA complicated by Escherichia coli bacteremia. She experienced acute abdominal pain, fever, nausea, and vomiting. An intrauterine contraceptive device (IUD) had been inserted one year prior to her presentation. She had a history of PID 20 years earlier. Pelvic computed tomography (CT) and transvaginal ultrasound showed findings consistent with TOA. After multiple courses of inpatient and outpatient antibiotics, she eventually underwent diagnostic laparoscopy, bilateral salpingectomy, and lysis of adhesions. During surgery, she was found to have extensive adhesions, bilateral salpingitis, and a right pyosalpinx suspicious for rupture or leaking. The timing of her IUD insertion and the onset of active pelvic infection was likely not coincidental. TOA complicated by E. coli bacteremia and suspected rupture or leakage presents a rare but serious clinical scenario. This case highlights the importance of early recognition of systemic infection signs, careful use of imaging and culture data, and prompt surgical intervention when conservative management fails.
Parchment et al. (Fri,) studied this question.