Pelvic inflammatory disease with tubo-ovarian abcsess, right sided hydrosalpinx and small uterine fibroids
40 years old female admitted with abdominal pain and diarrhoea. She was investigated for secondary sub-fertility 4 months previously. At that time hysterosalpingogram showed a large right sided hydrosalpinx and a normal left tube. She is pyrexial, CRP of 620, WBC of 24.
Loading Stack -
0 images remaining
- The uterus is slightly deviated to the left
- Superior and to the left of the uterus there is a large, thick-walled left ovarian cyst measuring 9.4 x 8 x 9.3 cm that is hyper intense on the T2 and high signal on the T1 suggesting either a high protein content or haemorrhage.
- Another thick-walled cystic area is seen ventral to the uterus and cranial to the bladder measuring 5 x 3 cm that also shows similar signal intensity.
- There is also evidence of left tubal dilatation.
- The right ovary also shows multiseptated cystic lesion measuring 3.6 x 5 cm and also appears thick-walled. This is associated with it right hydrosalpinx
1 case question available
Pelvic inflammatory disease (PID) is a common infection seen in non-pregnant women at reproductive-age. It is a major public health problem associated with substantial medical complications (tubo-ovarian abscess formation, pyosalpinx formation, infertility, peritonitis, adhesion formation with resultant bowel obstruction, Fitz-Hugh-Curtis syndrome). Prevention of these long-term complications requires management that is based on the microbiologic etiology of PID
This case was discussed at the multi-disciplinary meeting and decision was made for surgical management. Post operative patient was managed for abdominal sepsis with triple intra-venous antibiotics as indicated by the microbiologist (specimen grew E. Coli on cultures).
- Soper DE1, Pelvic inflammatory disease. Obstet Gynecol. 2010 Aug;116(2 Pt 1):419-28.
- Eschenbach DA. Acute pelvic inflammatory disease.Urol Clin North Am. 1984 Feb;11(1):65-81.
- Tukeva TA, Aronen HJ, Karjalainen PT et-al. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology. 1999;210 (1): 209-16.
- Sweet RL1. Treatment strategies for pelvic inflammatory disease. Expert Opin Pharmacother. 2009 Apr;10(5):823-37.