Tubo-ovarian abscess with sepsis in a nonagenarian woman: a case report and literature review

• Published in: BMC women's health Vol. 19; no. 1; p. 81
• Main Authors: Chen, Kuan-Yi, Tseng, Jen-Yu, Yang, Chih-Yu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.06.2019; BioMed Central; BMC
• Subjects: Abdominal Pain - etiology; Abscess - complications; Abscess - diagnostic imaging; Aged; Anti-Bacterial Agents - therapeutic use; B cells; Care and treatment; Case Report; Chronic kidney disease; Chronic kidney failure; Dementia; Diagnosis; Disease susceptibility; Fallopian Tube Diseases - complications; Fallopian Tube Diseases - diagnostic imaging; Female; Fever of unknown origin; Health aspects; Humans; Infection; Kidney diseases; Medical schools; Menopause; Mortality; Nonagenarian; Oophorectomy; Ovarian Diseases - complications; Ovarian Diseases - diagnostic imaging; Pelvic inflammatory disease; Pelvic Inflammatory Disease - complications; Pelvic Inflammatory Disease - diagnosis; Post-menopausal; Postmenopausal women; Salpingo-oophorectomy; Sepsis; Sepsis - complications; Sepsis - diagnostic imaging; Surgery; Tubo-ovarian abscess; Women; Post-menopausal; Case report; Chronic kidney disease; Fever of unknown origin; Tubo-ovarian abscess; Nonagenarian
• ISSN: 1472-6874; 1472-6874
• DOI: 10.1186/s12905-019-0782-6

A complete infectious focus survey relies on a thorough physical examination as well as a pelvic examination. Tubo-ovarian abscess, though less likely to occur in senior women, may become a life-threatening disease requiring emergent surgery. Hence, clinical awareness and aggressive management are warranted to avoid delayed diagnosis and subsequent complications. We report a post-menopausal woman presented with sepsis of unknown origin, which turned out to be a huge tubo-ovarian abscess. Although tubo-ovarian abscess mostly occurs in women of fertile age, it is likely that the immune status of our post-menopausal patient was compromised because of old age and uremia. Moreover, due to underlying dementia, she could not express her discomfort in the early stage. Her sepsis resolved after a unilateral salpingo-oophorectomy surgery and antibiotic treatment. It is crucial to exclude pelvic inflammatory disease (PID) if no specific source of infection can be identified. Rupture of the tubo-ovarian abscess is a condition of high mortality rate. Although tubo-ovarian abscess is more likely to develop in patients aged 15-25 years old, the tubo-ovarian abscess should be listed as a differential diagnosis in all post-menopausal women, especially those who are immunocompromised or with a palpable pelvic mass, to enable timely management and better prognosis.