Tubo-ovarian abscess complicated by intestinal obstruction due to adhesions
Presentation
Acute abdominal pain with symptoms of intestinal obstruction. No previous abdominal surgery.
Patient Data
Dilated serpiginous structure is seen at the left adnexa representing dilated left fallopian tube with adjacent multilobulated cystic lesion has thick enhanced wall representing tubo-ovarian abscess. It is associated with stranding of the surrounding fat planes. The adjacent ileal loops are adherent to the abscess with dilatation of the proximal small bowel loops denoting intestinal obstruction. The transition point is at the level of the adnexal abscess. The distal ileal loops are collapsed. No bowel ischemia or perforation.
Reactive inflammation of the sigmoid colon and rectum.
Improper position of the intra uterine contraceptive device (IUCD) seen at the lower uterine segment with its transverse part piercing the left myometrial wall.
A large right adnexal thin-walled cyst measuring 9cm in diameter is seen, it shows internal small daughter cyst but no solid component.
Multiple gall bladder stones.
Case Discussion
Intra-operatively, a small bowel loop was found to be amalgamated with left adnexal abscess causing proximal intestinal obstruction.
The misplaced IUCD might have predisposed the patient to the pelvic inflammatory disease and tubo-ovarian abscess.