Presentation
2 weeks of lower abdominal / pelvic pain. Passing mucus PR. Tender and febrile.
Patient Data
Erect and supine abdominal films have been obtained demonstrating a paucity of bowel gas within the pelvis, appearing to displace loops of bowel upwards. No evidence of free intra-abdominal gas.
Partial sacralization of the left side of the L5 vertebral body is noted.
Within the pelvis there is a large cystic structure with enhancing walls. The mass displaces the uterus anteriorly. Free fluid is seen within the pelvis and right paracolic gutter.The ovaries are not well seen. The appendix appears normal.
Transabdominal scanning has been performed.
A 9 cm cystic mass, filled with homogeneous low echo content, is confirmed in the right adnexal region, with similar left adnexal 6 cm cystic mass, and complex heterogeneous (mixed solid-cystic) appearance extending between the collapsed rectum and anteriorly displaced uterus.
Case Discussion
This patient went on to have a laparoscopy confirming a right 9cm tubo-ovarian abscess and a left tubo-ovarian abscess 4cm, with extensive adhesions involving the surrounding bowel. She had salpingectomy and bilateral drains inserted.
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