Document Type : Case Report

Authors

1 Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

2 Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Abstract

The aim of this study is to report a case of a tubo-ovarian abscess (TOA) in pregnancy. TOA is a complex infectious mass of the adnexa that develops as a consequence of pelvic inflammatory disease, mostly found in reproductive age women. However, incidences in pregnant woman are considering extremely rare. The recent study regarding TOA in pregnancy was conducted in 2021 with only 40 cases reported. It risks a maternal morbidity, mortality, and fetal jeopardy. To conduct this study, the case was a 28 years-old woman, 24/25 weeks primigravidae presenting at Dr. Soetomo Hospital emergency room with chief complaints abdominal pain, fever, and abdominal tenderness. Laboratory examination revealed leukocytosis, elevated CRP, and Procalcitonin. Abdominal MRI showed a right adnexal mass measuring ± 7.2 x 5.1 x 2.9 cm. Emergency laparotomy was performed due to the presence of peritonitis, a ruptured TOA and appendix inflammation were found. Abscess drainage followed by cyst wall excision, irrigation, and appendectomy were done. Microbiological culture was performed on abdominal pus samples taken during surgery. A histopathological and microbiological examination confirmed the diagnosis of TOA. The TOA occurrence in pregnancy is hardly recorded due to its low prevalence. Diagnosing during pregnancy can be difficult due to the similarity of symptoms and laboratory findings with other illnesses. Although rare, TOA in pregnancy can cause a poor prognosis for both the pregnant mother and the fetus. Diagnosis is also not easy because of its rarity. Making a prompt diagnosis can help to improve the outcomes.

Graphical Abstract

Rupture of tubo-ovarian abscess in second trimester of pregnancy: A case report at Dr. Soetomo Hospital Surabaya

Keywords

Main Subjects

[1] S.L. Hillier, K.T. Bernstein, S. Aral, A review of the challenges and complexities in the diagnosis, etiology, epidemiology, and pathogenesis of pelvic inflammatory disease,  The Journal of Infectious Diseases, 2021, 224, 23–28. [Crossref], [Google Scholar], [Publisher]‎
[2] A. Curry, T. Williams, M.L. Penny, Pelvic inflammatory disease: diagnosis, management, and prevention, American Family Physician, 2019, 100, 357–364. [Google Scholar], [Publisher]‎
[3] J. Ross, M. Chacko M, Pelvic inflammatory disease: Clinical manifestations and diagnosis, Up-ToDate Waltham MA, 2019. [Google Scholar], [Publisher]‎
[4] D.D. Pratapwar, N.M. Bhure, S.P. Zunjare, A case report: ruptured primary ovarian abscess in pregnancy, International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021, 10, 3627. [Crossref], [Publisher]‎
[5] K. Munro, A. Gharaibeh, S. Nagabushanam, C. Martin, Diagnosis and management of tubo‐ovarian abscesses, The Obstetrician & Gynaecologist, 2017, 20, 11-19. [Crossref], [Google Scholar], [Publisher]‎
[6] A.D.B. Vuong, P.N. Nguyen, An extremely rare case of ovarian abscess in third trimester of pregnancy managed by successful vaginal birth and review of literature, International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2022, 11, 924. [Crossref], [Google Scholar], [Publisher]‎
[7] Y.A. Kim, K.C. Chun, J.W. Koh, H.S. Song, H.S. Kim, How to approach the rupture of tubo-ovarian abscess during pregnancy: A case report and literature review, The Journal of Obstetrics and Gynaecology Research, 2021, 47, 1199–1203. [Crossref], [Google Scholar], [Publisher]‎
[8] P. Brandão, A. Portela-Carvalho, C. Estevinho, E. Soares, A. Melo, Tubo-ovarian abscess in early pregnancy- report of a rare coexistence, Obstet Gynaecol Cases - Rev, 2018, 5, 5–8. [Crossref], [Google Scholar], [Publisher]‎
[9] R. Floyd, B. Anglim, Tubo-ovarian abscess after vaginal delivery: A case report and review of current literature, Case Reports Women’s Heal, 2023, 39, 526. [Crossref], [Google Scholar], [Publisher]‎
[10] G. Augustin, Complicated pelvic inflammatory disease, In: Acute Abdomen During Pregnancy, Cham: Springer International Publishing, 2023, 331–356. [Crossref], [Google Scholar], [Publisher]‎
[11] A. Hsu, B.K. Sarowa, S.F. Abdessalam, Ruptured appendicitis leading to development of a tubo-ovarian abscess in a non-sexually active adolescent patient, Cureus, 2023, 15. [Crosref], [Google Scholar], [Publisher]‎
[12] N. Kairys, C. Roepke, Tubo-ovarian abscess, In: Stat Pearls, Stat Pearls Publishing, 2023. [Google Scholar], [Publisher]‎
[13] N. Tabibian, E. Swehli, A. Boyd, A. Umbreen, J.H. Tabibian, Abdominal adhesions: A practical review of an often overlooked entity, Annals of Medicine and Surgery (2012), 2017, 15, 9–13. [Crossref], [Google Scholar], [Publisher]‎
[14] C. Han, C. Wang, X.J. Liu, N. Geng, Y.M. Wang, A.P. Fan, et al, In vitro fertilization complicated by rupture of tubo-ovarian abscess during pregnancy, Taiwanese Journal of Obstetrics and Gynecology, 2015, 54, 612–616. [Crossref], [Google Scholar], [Publisher]‎
[15] M. Andalas, M. Munawar, Y. Yusra, M. Maqbul, Tubo-ovarian abscess: in Dr. Zainoel Abidin Banda Aceh Hospital: A case report, Journal Of The Indonesian Medical Association, 2020, 70, 128–131. [Crossref], [Google Scholar], [Publisher]‎
[16] Y. Julhijrianto, H. Novida, Pre-operative management of a patient with tubo-ovarian abscess and diabetic ketoacidosis, Bali Medical Journal, 2023, 12, 3331–3336. [Crossref], [Google Scholar], [Publisher]‎
[17] G.M. Taylor, A.H. Erlich, L.C. Wallace, V. Williams, R.M. Ali, J.P. Zygowiec, A tubo-ovarian abscess mimicking an appendiceal abscess: A rare presentation of Streptococcus agalactiae, Oxford Medical Case Reports, 2019, 2019, 337–341. [Crossref], [Google Scholar], [Publisher]‎
[18] J.M. Horowitz, I.M. Hotalen, E.S. Miller, E.L. Barber, S. Shahabi, F.H. Miller FH, How Can Pelvic MRI with Diffusion-Weighted Imaging Help My Pregnant Patient?, American Journal of Perinatology, 2020, 37, 577–588. [Crossref], [Google Scholar], [Publisher]‎
[19] D.R. Gopireddy, M. Virarkar, S. Kumar, S.S. Vulasala, L.S. Nwachukwu C, Acute pelvic pain: A pictorial review with magnetic resonance imaging, Journal of Clinical Imaging Science, 2022, 12, 48. [Crossref], [Google Scholar], [Publisher]‎
[20] M. Sönmezer, K.G. Saçıntı, B. Varlı, Y.E.
Şükür, Ç. Gülümser, B. Özmen, C.S. Atabekoğlu, B. Berker, R. Aytaç, M. Sönmezer, Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?, G Ginekologia Polska, 2023,  94, 95–100. [Crossref], [Google Scholar], [Publisher]‎
[21] A.F. Kemalasari, P. Widiasih P, Ovarian tube abscess in an intrauterine contraceptive device user for 5 years: A case report, Journal of Social Research, 2021, 2, 3906–3911. [Crossref], [Google Scholar], [Publisher]‎
[22] G.L. Nugraha, D. Septarendra, T. Lesmana T, Comparative study of SOFA, WSESSSS, and CPIRO scoring systems as mortality predictors in a patient with complicated intra-abdominal infection, Bali Medical Journal, 2022, 11, 1397–1403. [Crossref], [Google Scholar], [Publisher]‎
 [23] B.M. Hota, RK, Radha, P.G. Channa Basavaih, Giant ovarian cyst in term pregnancy- A rare case report, Bali Medical Journal, 2015, 4, 5–7. [Crossref], [Google Scholar], [Publisher]‎
 [24] A.N.M. Ansori, M.H. Widyananda, Y. Antonius, A.A.A. Murtadlo, V.D. Kharisma, P.A. Wiradana, S. Sahadewa, F.D. Durry, N. Maksimiuk, M. Rebezov, R. Zainul, A review of cancer-related hypercalcemia: Pathophysiology, current treatments, and future directions, Journal of Medicinal and Pharmaceutical Chemistry Research, 2024, 6, 944-952. [Crossref], [Publisher]‎