Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.
PIP: This paper presents the case of a 32-year-old woman who developed a tubo-ovarian abscess 7 years following tubal ligation via minilaparotomy. Symptoms experienced included pain, which was exacerbated by walking, and mild deep dyspareunia. Abdominal and pelvic examinations revealed pain in the left iliac fossa, cervical excitation tenderness, and an ill-defined left adnexal mass. Sonographic evaluation of the pelvis showed an irregularly shaped, cystic mass (8.0 x 4.5 x 5.3 cm) with thickened internal septations and solid parts. A left tubo-ovarian multilobulated complex mass adherent to the omentum and the pelvic side was found upon laparotomy. There was pus in the Pouch of Douglas, and the uterus was 10 weeks in size with symmetrical enlargement. The previously ligated right fallopian tube and the ovary were unremarkable. Management includes left adnexectomy, omental biopsy, and 5-day course of antibiotics against Staphylococcus aureus, which was cultured from the purulent material in the Pouch of Douglas. Tubo-ovarian abscess should be considered in diagnosing patients presenting symptoms of pelvic inflammatory disease.