Mendez L E, Bhoola S M, Horowitz I R
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
Infect Dis Obstet Gynecol. 1998;6(3):138-40. doi: 10.1002/(SICI)1098-0997(1998)6:3<138::AID-IDOG8>3.0.CO;2-T.
Pelvic inflammatory disease (PID) is a common gynecologic disorder. One known complication of PID is tubo-ovarian abscess (TOA) formation. The predominant theory on TOA formation postulates that an ascending infection from the cervix through the uterus to the fallopian tubes and ovaries results in abscess formation. Other theories include seeding via a hematogenous infection, diverticular disease, and appendicitis.
A 39-year-old female patient with abdominal pain was referred to our institution and was found to have a pelvic mass. After a thorough evaluation, surgical exploration revealed the presence of TOA. No evidence of gastrointestinal disease was present. The patient's history was significant for an uncomplicated total abdominal hysterectomy for benign disease of the uterus four years prior. Abscess cultures grew Streptococcus intermedius.
This case reports the rare occurrence of TOA in a patient who had undergone an abdominal hysterectomy four years prior to presentation. If the patient reports a surgical history of prior hysterectomy, TOA is often stricken from consideration. Although unlikely, adnexal abscess formation should be considered in the differential diagnosis of a patient with abdominal pain and a pelvic mass, even with a remote history of hysterectomy.
盆腔炎性疾病（PID）是一种常见的妇科疾病。PID的一种已知并发症是输卵管卵巢脓肿（TOA）形成。关于TOA形成的主要理论假定，从宫颈经子宫向上蔓延至输卵管和卵巢的感染会导致脓肿形成。其他理论包括血源性感染、憩室病和阑尾炎引发的感染。
一名39岁腹痛女性患者被转诊至我院，检查发现盆腔有肿物。经过全面评估，手术探查发现存在TOA。未发现胃肠道疾病迹象。患者有重要病史，四年前因子宫良性疾病接受了无并发症的全腹子宫切除术。脓肿培养物中生长出中间型链球菌。
本病例报告了一名患者在出现症状前四年接受腹部子宫切除术后罕见地发生TOA的情况。如果患者报告有既往子宫切除术的手术史，TOA通常不被考虑。尽管可能性不大，但对于有腹痛和盆腔肿物的患者，即使有远期子宫切除术病史，在鉴别诊断中也应考虑附件脓肿形成的可能。
