Chronic ectopic pregnancy presenting as a suspected tubo-ovarian abscess: a diagnostic dilemma.

Though there is no definite agreement on diagnostic criteria or definition of chronic ectopic pregnancy (CEP), it could be deemed to be a variant of pregnancy of unknown location with non-specific clinical signs and symptoms. This was a case of a para 2+2 who presented with lower abdominal pain and bleeding per vaginum, and initial ultrasound was suggestive of a tubo-ovarian abscess/mass. With a further MRI scan and a diagnostic laparoscopy, she was found to have a CEP and had a laparoscopic salpingectomy for management. The diagnosis of CEP could be quite challenging as a result of the protracted symptoms, often negative/low serum B-HCG and ultrasound features mimicking a pelvic mass. A high index of suspicion is needed, and an MRI scan and diagnostic laparoscopy often aid in diagnosis and management.

Xanthogranulomatous salpingo-oophoritis presenting as an ovarian tumour.

Xanthogranulomatous salpingo-oophoritis (XGSO) is an exceptionally rare entity. Its clinical manifestations and imaging modalities can mimic benign and malignant adnexal diseases, making it difficult to diagnose. Here we report a case of XGSO in a young woman who was operated with suspicion of a borderline ovarian tumour. Preoperative diagnosis of XGSO should be considered to avoid radical surgical treatment, especially in young patients.

Tubo-ovarian abscess infected by Salmonella typhi.

We report a case of a tubo-ovarian abscess infected with Salmonella enterica serotype typhi A 19-year-old Nepalese woman presented to a hospital in Kathmandu with lower abdominal pain, constipation, fever and a non-healing, suppurative surgical wound from an emergency caesarian section performed 2 months previously at 37 weeks of pregnancy. She also had an exploratory laparotomy for an appendix perforation with peritonitis at 25 weeks of gestation. Her wound infection did not respond to cloxacillin and she had an exploratory laparotomy, and a tubo-ovarian abscess was found from which S. typhi was isolated. She had a bilateral salpingo-oophorectomy and responded to 14 days of chloramphenicol. A tubo-ovarian abscess is a rare complication of enteric fever.

Case Of Xanthogranulomatous Oophoritis.

Xanthogranulomatous inflammation is characterized by destruction of the tissues of the organ involved and replacement by chronic inflammatory cells such as lymphocytes, plasma cells, occasional neutrophils with or without multinucleated or Touton giant cells. Exact aetiology is not known but the theory of infection with organisms like Proteus, E coli, and Bacteroides fragilis is most popular. Xanthogranulomatous inflammation of the female genital tract is not common and usually involves the endometrium; however, xanthogranulomatous inflammation of the ovaries is a rare entity.

Enterobius vermicularis in tubo-ovarian abscess: A rare and interesting incidental finding - A case Report.

Enterobius vermicularis is a common intestinal nematode; however, rare extraintestinal Enterobius infections have been reported from different parts of the world. Here, we present a case of tubo-ovarian abscess in an otherwise healthy young sexually active female with no known comorbids with history of on and off lower abdominal pain for one year and high grade fever for one month. On the basis of further workup and radiological evaluation, a preoperative diagnosis of right sided tubo-ovarian abscess was made and salpingo-oophorectomy was performed laproscopically in July 2015. Histopathology of the resected tissue revealed necrosis and in one area Enterobius vermicularis was identified surrounded by neutrophils and eosinophil rich abscess. A final diagnosis of severe acute and chronic salpingo-oophoritis with abscess formation, secondary to Enterobius vermicularis was made. Signs and symptoms of parasitic involvement in tubo-ovarian abscesses are not much different than usual presentations of pelvic inflammatory diseases and identification of a parasite in a tubo-ovarian tissue sample is a rare clinical finding. A high index of suspicion on the part of histopathologist as well as clinician is important for timely diagnosis and effective management of such cases.

A case report of a 19-week gravid patient with a dehisced abdominal wound and treated with V.A.C. ATS(®) Therapy System.

Negative pressure wound therapy (NPWT) is an effective treatment for various non-healing wounds, and V.A.C.(®) Therapy was the first-approved NPWT device by the Japanese government in 2009. We report the case of a 19-week pregnant patient where V.A.C.(®) Therapy was applied to her dehisced laparotomy wound with satisfactory results. The patient was a 30-year-old female who was referred to our hospital from her previous doctor because of the presence of an ovarian cyst on the left ovary. The patient presented at 14 weeks into her pregnancy, and surgery was considered because of no reduction in the size of the cyst. An oophorocystectomy was performed, and then the surgical incision was re-opened at postoperative day (POD) 10 due to a surgical site infection. V.A.C.(®) Therapy was initiated on POD 26 (20 weeks of pregnancy) and continued for 28 days. After 28 days of V.A.C.(®) Therapy (POD 54), the wound was sutured for complete closure. The foetus did not experience any adverse affects from the surgery and, subsequently, normal vaginal delivery was achieved. This case is the first report of the use of V.A.C.(®) Therapy over a dehisced abdominal wound on a pregnant patient in our country.

Xanthogranulomatous oophoritis mimicking malignancy: a diagnostic dilemma.

Xanthogranulomatous inflammation is a chronic condition in which the affected organ is replaced by lipid-filled macrophages with plasma cells, lymphocytes and neutrophils. It is very rare in the ovaries. A case of xanthogranulomatous oophoritis in a premenopausal multiparous woman presenting with abnormal uterine bleeding and adnexal mass whose clinical and imaging findings suggested malignancy is reported.

[Spontaneous renal forniceal rupture with suspicious ovarian mass]. / Urétéro-hydronéphrose avec rupture du fornix sur masse ovarienne suspecte.

Extravasation of urine following rupture of the renal fornix is a rare complication mostly caused by obstruction secondary to distal ureteric stones. This 35-year-old woman was referred with back pain. Her CT scan revealed rupture of the renal fornix secondary to a pelvic mass. Laparoscopy subsequently confirmed this to be an ovarian abscess. We report the first case of spontaneous renal forniceal rupture secondary to pelvic inflammatory disease.

Xanthomatous oophoritis following uterine artery embolisation: successful conservative surgical management with favourable outcome.

Xanthomatous oophoritis is a rare inflammatory condition of the ovaries. We are reporting a case of a 28-year-old woman, who had undergone uterine artery embolisation 4 years ago due to symptomatic focal adenomyosis. After 3 years of embolisation, the patient started having chronic pelvic pain, dysmenorrhoea and polymenorrhagia along with inability to conceive. Abdominal examination showed 16 weeks size mass arising from the pelvis. Ultrasound findings were suggestive of focal adenomyosis and bilateral tubo-ovarian masses. A CT scan report showed cystic enlargement of ovaries showing high-density fluid contents. MRI showed two well-defined, thick-walled, septated, cystic lesions appearing hyperintense on both T1-weighted (T1w) and T2w images with peripheral and septal enhancement. Bilateral abscess walls were excised and the healthy ovarian tissue was left behind during surgery. Histopathology of the cyst wall showed xanthomatous oophoritis. After the conservative surgery, she received three doses of goserelin. She conceived spontaneously thereafter and delivered a healthy term baby.

Xanthogranulomatous oophoritis: pathologic findings with clinical correlation.

Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that destroys the affected organs. It is characterised by the presence of lipid laden macrophages, lymphocytes, plasma cells, neutrophils, multinucleate giant cells and foci of necrosis. Only a few cases of xanthogranulomatous Inflammation exclusively involving the ovary have been reported till date. The case presented here was associated with fever, abdominal mass and Escherichia coli infection. A knowledge of this entity is essential to avoid a misdiagnosis of malignancy and extensive surgery.

Resolution of autoimmune oophoritis after thymectomy in a myasthenia gravis patient.

Myasthenia gravis (MG) is an autoimmune disorder characterized by autoantibodies against acetylcholine receptors. MG is generally an isolated disorder but may occur concomitantly with other autoimmune diseases. We describe an eighteen-year-old girl with MG who was admitted to our clinic with secondary amenorrhea and diagnosed as autoimmune oophoritis. Since her myasthenic symptoms did not resolve with anticholinesterase therapy, thymectomy was performed. After thymectomy, her menses have been regular without any hormonal replacement therapy. To our knowledge, this is the first report on a patient with autoimmune ovarian insufficiency and MG in whom premature ovarian insufficiency resolved after thymectomy, without hormonal therapy.

Tubo-ovarian abscess during therapy of chronic hepatitis C with pegylated interferon and ribavirin.

BACKGROUND: Serious infections are rare complications of standard treatment in chronic hepatitis C with pegylated interferon alpha (Peg IFN) and ribavirin. CASE: We report two cases of life-threatening tubo-ovarian abscess (TOA) in women older than 40 year of age. No casual risk factors of TOA could be identified in them. In one case septic shock and acute renal failure occured. TOA was caused by endogenic bacteria (Porphyromonas asaccharolytica in the first case and Streptococcus intermedius in the latter). Surgical treatment and interruption of IFN therapy was necessary in both cases. CONCLUSIONS: Serious gynecological infections may have the significant negative influence on chronic hepatitis C therapy outcome. Because of the risk of TOA developing during IFN therapy gynecological care is needed in chronic hepatitis C management.

A case of ovarian actinomycosis.

BACKGROUND: Pelvic actinomycosis is uncommon and often presents as a complication of an intrauterine device (IUD). A diagnosis of actinomycosis can be made from the finding of sulfur granules within inflammatory exudate on histologic examination after surgery. However, it may be possible to diagnose actinomycosis before surgery by finding Actinomyces-like organisms on Papanicolaou smears. CASE: A 41-year-old woman had been diagnosed as having a pelvic abscess, and bilateral salpingo-oophorectomy was performed. She had been an IUD user for 6 years. Actinomyces-like organisms were detected in her previous Papanicolaou cervical smears. If the patient had been treated when the Actinomyces-like organisms were detected by Papanicolaou smears, the serious ovarian actinomycosis might have been avoided. CONCLUSION: We suggest that routine cervical examinations are important for women who are IUD users.

Tubo-ovarian abscess after colonic vaginoplasty for high cloacal anomaly in a 13-year-old girl.

Recently a few articles have been published concerning the long-term follow-up of vaginoplasty of cloaca. However, no postoperative evaluation has been fully described and, in particular, the late complications are still unknown. We report a case of tuboovarian abscess after colonic vaginoplasty for high cloacal anomaly in a 13-year-old girl. She required a left salpingo-oophorectomy and postoperatively showed regular menstruation. Therefore we stress that tubo-ovarian abscess is one of the important late complications after colonic vaginoplasty for high cloacal anomaly.

Xanthogranulomatous salpingitis and oophoritis: a case report and review of the literature.

A case of xanthogranulomatous salpingitis and oophoritis in a 47-year-old woman is presented. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that is destructive to affected organs; it is characterized by the presence of lipid-filled macrophages with admixed lymphocytes, plasma cells, and neutrophils. Only a few cases of xanthogranulomatous salpingitis and oophoritis have been reported to date. The case presented here is associated with Escherichia coli infection, endometriosis, and an intrauterine device.

[Secondary infection of the ovarian endometriotic cysts].

OBJECTIVE: To explore the clinic manifestations, diagnostic methods and principles of management in the secondary infection of the endometriotic cysts of ovary. METHODS: Thirteen cases of the infected ovarian endometriotic cysts were analysed retrospectively in our hospital from Jan. 1990 to Dec. 1996. The diagnosis was confirmed by the operation and pathologic findings. RESULTS: The clinic manifestations were divided into five types, namely acute, subacute, chronic, occult and stabile types. The definitive diagnosis can be made by abdominal pain, fever and adnexal mass combined with B-scan findings and chocolate-brown purulent fluid which was punctured from the adnexal mass. Operation was the main method for treatment. CONCLUSIONS: Secondary infection of the endometriotic cyst is one of the gynecologic emergency. Correct diagnosis and prompt management are of vital importance.

[Ileus in late pregnancy--sequela of follicle puncture within the scope of in vitro fertilization?]. / Ileus in der Spätschwangerschaft--Folge der Follikelpunktion im Rahmen der In-vitro-Fertilisation?

Complications in connection with the puncture in in-vitro fertilisation (IVF) occur normally relatively soon after the operation. This is a report on a patient in her 28th week of gestation, operated on by laparotomy for ileus. Retrospectively this acute event must be seen as a very rare late complication connected with the puncture. It must be stressed that patients should be informed about this eventually.

[Abdominal actinomycosis in tubo-ovarian abscess]. / Abdominelle Aktinomykose bei Tubovarialabszess.

Diagnosis of actinomycosis as a specific infection is rather difficult. By a case report it is described that preoperative diagnostics and intraoperative situs do not always exactly clarify the situation. In most cases the definite diagnosis can only be achieved by histological findings followed by an adequate therapy.