Pelvic inflammatory disease with tubo-ovarian abcsess, right sided hydrosalpinx and small uterine fibroids

Case contributed by Dr Horea Craciun

Presentation

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.

Patient Data

Age: 40
Gender: Female
  • 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

Case Discussion

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).

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Case Information

rID: 36999
Case created: 21st May 2015
Last edited: 5th Sep 2015
System: Gynaecology
Inclusion in quiz mode: Included

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