Postpartum tubo-ovarian abscess, likely arising from pelvic inflammatory disease during pregnancy.

Abdou R, Miller T. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220183 DESCRIPTION A female aged 18 years presented 2 weeks postnormal vaginal delivery with worsening generalised abdominal pain radiating to the back since delivery, with associated night sweats. She was vomiting, had loose bowel motions and had difficulty passing urine, but denied dysuria. On examination, she was febrile, tachypnoeic and tachycardic, and had a pale complexion. Her abdomen was distended with maximal tenderness in the left illiac fossa and associated rebound and percussion tenderness. She was unable to pass urine in the emergency department. Blood tests demonstrated a raised white cell count, C reactive protein 344 and CA-125 145. She had a CT abdomen which showed a large pelvic abscess (figure 1 and figure 2) with internal septations posterior to the uterus (figure 3) and bilateral hydronephrosis and hydroureter. She was given intravenous antibiotics and underwent a laparotomy with drainage of pelvic abscess. Intraoperative findings included an extensive pelvic abscess containing purulent fluid, contained by a thick-walled peritoneum and omentum which were oedematous. The abscess appeared to be arising from a right tubo-ovarian abscess, with purulent exudate throughout the pelvis and gross appearance of acute salpingitis. The small and large bowel were also noted to be oedematous. In total, 2.9 L of pus was drained and the abdomen was extensively washed out. Histopathology of the omental biopsy showed inflamed and haemorrhagic granulation tissue consistent with abscess wall. Cyst fluid cytology showed degenerate acute inflammatory cells, consistent with an abscess. On examination of her obstetric ultrasounds, it became clear that she had increasing amounts of free fluid in the pelvis with 98 mL in the Pouch of