Ovarian abscess

Case contributed by Yaïr Glick


Severe abdominal pain, nausea, and vomiting. Marked leukocytosis. Difficulty conceiving due to endometriosis, currently undergoing IVF.

Patient Data

Age: 35 years
Gender: Female

Abscess involving left ovary and possibly left salpinx (tubo-ovarian abscess?) measuring 4.7 x 6.0 x 4.9 cm, with focal defect of wall enhancement, probably representing a hole through which pus is oozing.
Small amount of free intraperitoneal fluid measuring 23-25 HU in density, most of it pelvic, with mesenteric and perihepatic locules - most probably purulent fluid not yet organized.
Right ovarian cyst measuring 2.4 cm in diameter and 25 HU in density that could represent a simple cyst or possibly, an endometrioma.
Small subserosal fibroid jutting out from the posterior uterine wall.

Case Discussion

Sudden abdominal pain, accompanied buy vomiting and chest pain. On the morning of admission, the pain had started projecting to the shoulders, the vomiting persisted, and diarrhea appeared.
History of antiphospholipid syndrome (APLA) and endometriosis, Nulliparous, currently undergoing in vitro fertilization (IVF) treatment.
CT showed a left adnexal abscess and thick intraperitoneal fluid, most probably pus that had oozed from the abscess.

On entering the abdominal cavity, ~100 ml of purulent fluid was seen. Uterus appeared normal, with 2-cm subserosal leiomyoma located left posterior at level of isthmus. Fibrin covering the uterus and in the pelvis. Normal right ovary and salpinx. Left salpinx mildly hyperemic. Left ovary - 5-cm or larger cyst with a hole in its wall that exuded pus. The abscess was lanced and its contents were suctioned. Cystectomy performed. Of note, no endometrial implants seen in the pelvis.

Fluid from the abdominal cavity was sent for PCR and culture and yielded E. faecalis.

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