Philippine E-Journals

Tubo-Ovarian Abscess Complicating an Endometrioma in a Non-Sexually Active Adolescent with Uterine Didelphys

Sarah Abigail N. Manalang | Darlene Minette Zamora

 

Abstract:

Tubo-ovarian abscesses (TOA) are almost always a complication of pelvic inflammatory disease (PID). PID is the infection of the upper genital tract commonly caused by ascending infection from sexually-transmitted microorganisms. There are, however, very rare cases of PID described in non-sexually active patients, with an incidence of 4.1%. Multiple risk factors are implicated for developing TOA, including the presence of an endometrioma which is the localization of endometrial tissue in the ovary. This may be due to retrograde menstruation which is particularly more common in patients with obstructive müllerian anomalies. This is a case of a 14-year-old female, non-sexually active, with uterine didelphys, and with history of exploratory laparotomy and appendectomy for primary bacterial peritonitis two years prior to this admission. She sought consult at the emergency room for severe abdominal pain and was subsequently admitted with an initial diagnosis of probable post-operative adhesions. Diagnostic work-up revealed findings of fecal stasis, uterine didelphys, right ovarian new growth, and ascites. She again underwent exploratory laparotomy, right oophorocystectomy, adhesiolysis, and omentectomy. Intraoperative findings were right endometrioma complicated by TOA and severe adhesions. It is therefore the aim of this study to report a rare case of an adolescent who was non-sexually active, with uterine didelphys, and an endometrioma complicated by TOA; and to emphasize the significance of including these entities in the differential diagnoses of adolescents complaining of moderate to severe pelvic pain to prevent appalling complications in the reproductive capacity of the patient.