Diverticulitis mimicking a tuboovarian abscess. Report of a case in a young woman.

BACKGROUND

Diverticulitis is an uncommon condition in young women. When it occurs, it is often not recognized until complications such as perforation or fistulization occur. There has been no recent discussion in the gynecologic literature of diverticulitis in a young woman presenting as gynecologic disease.

CASE

A 31-year-old woman with a long history of "irritable bowel syndrome" developed a 4-5-cm left adnexal mass associated with mild discomfort and dysparunia. Acute worsening of her pain led to abdominal exploration and left salpingo-oophorectomy for an unruptured tuboovarian abscess. She initially improved but then developed a recurrent pelvic abscess. Workup revealed extensive diverticulosis with probable sigmoid diverticulitis. Reexploration, drainage of the abscess and fecal diversion were required.

CONCLUSION

Because of the proximity of the left ovary to the sigmoid colon, it is possible for diverticulitis to perforate into the ovary, producing a tuboovarian abscess indistinguishable from that due to other more common causes. A high index of suspicion is required to make the diagnosis, especially in young women. Failure to treat underlying diverticulitis can lead to persistent or recurrent pelvic infection.