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Abstract: The patient had a past history of chronic pelvic inflammatory disease for many years and still had irregular episodes, which, together with the recent recurrent mycosis fungoides, indicated that the patient had low body resistance. The infection worsened after menstruation with abdominal pain and hyperthermia. Ultrasound examination suggested a mass in the left adnexal area with elevated leukocytes and ultrasensitive C-reactive protein. Anti-inflammatory treatment was given with poor results and surgery was performed instead, and an abscess in the left fallopian tube and ovary was seen intraoperatively. After removal of the abscess and continued anti-inflammatory treatment, the condition was controlled and the patient recovered.
Basic information】Female, 43 years old
Type of disease】Fallopian tube ovarian abscess
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】April 2022
Treatment plan】Surgical treatment (laparoscopic surgery) + medication (Ceftriaxone sodium for injection, metronidazole injection)
Treatment period】12 days in hospital
【Treatment effect】The condition was controlled, and the symptoms of high fever and abdominal pain disappeared
I. Initial consultation
Patient’s description: 3 previous abortions, 2 normal births, ligation and contraception. She had a history of chronic pelvic inflammatory disease for nearly 5 years, with irregular episodes of abdominal pain and abnormal leucorrhea, and had been treated at the hospital, but the symptoms still recurred. After February this year, due to the rainy weather, the patient developed mycosis vaginalis several times and was treated with nifurtimox vaginal soft capsule and red nucleus feminine cleansing lotion, which improved after use, but soon after stopping the medication, she had another attack. On April 2, her abdominal pain worsened and she started to have fever, during which her body temperature was as high as 38℃. She was diagnosed with left adnexitis and admitted to hospital.
II. Treatment
After admission, she took a detailed medical history and was given laboratory tests and examinations, including routine blood results: leukocytes: 18.75×10^9/L, ultrasensitive C-reactive protein 56.02mg/L, ultrasound results showed a mass of about 45×30mm in the left adnexal area, the left ovary was not visible, the uterus and right adnexa did not show any obvious abnormalities. At present, the possibility of long-term recurrent inflammatory infection leading to left fallopian tube ovarian abscess was considered, and intravenous anti-inflammatory treatment with ceftriaxone sodium for injection and metronidazole injection was given. After 2 days of treatment, the patient remained hyperthermic, and a repeat ultrasound showed a mass of about 58×37 mm in the left adnexal area. The patient was 43 years old and had no fertility requirements. She was given a left adnexal resection and metronidazole injection to flush the pelvic cavity, and the anti-inflammatory treatment was continued after the operation.
III. Treatment effect
Three days after the operation, the patient’s body temperature returned to normal, abdominal pain was significantly reduced, and the routine blood count was 12.46×10^9/L and ultrasensitive C-reactive protein was 18.70 mg/L, indicating that the treatment was effective, and intravenous anti-inflammatory treatment was continued. After 12 days of hospitalization, the patient’s vital signs were normal, no fever, no abdominal pain, good healing of abdominal wounds, routine blood count leukocytes 8.05×10^9/L, ultrasensitive C-reactive protein 8.18mg/L, and no obvious abnormalities in the pelvis on ultrasound examination, indicating that the inflammation had been effectively controlled, the patient was discharged and advised to continue outpatient treatment.
(Discharge diagnosis)
IV. Notes
We are glad that the patient’s disease has improved after treatment, but the patient has a history of pelvic inflammatory disease for many years, so it is difficult to cure completely with one treatment. We recommend the patient to continue treatment in the outpatient clinic, to perform pelvic physiotherapy in the outpatient clinic after menstruation, and to avoid premature sexual life. The recurrence of inflammation is related to the decrease of the patient’s body resistance. It is recommended that the patient increase the diet nutrition, supplement fresh fruits and vegetables, eat less fried, barbecued and spicy food, exercise more and stay up less. The patient’s recurrent episodes of pelvic inflammatory disease may be related to pelvic floor dysfunction. The patient is advised to go to the outpatient clinic for pelvic floor function assessment and pelvic floor rehabilitation treatment if necessary.
V. Personal insight
Tubo-ovarian abscess is a more serious degree of pelvic inflammatory disease, and if it is not treated effectively, the abscess may rupture with very serious consequences, so generally, when a tubo-ovarian abscess is found, broad-spectrum antibiotics are given for 2-3 days in treatment. If the treatment is not effective and the disease cannot be controlled, surgery should be performed as soon as possible. For young patients, try to preserve the ovarian tissue, while for those who are similar in age to the patient in this case and have no need for fertility and have recurrent disease, it is recommended to remove the affected adnexa to avoid recurrence of the disease.