Case 1: Persistent Fevers and Abdominal Pain in a 13-Year-Old Neutropenic Patient

A Case of Tubo-Ovarian Abscess in a 15-Year-Old Female After Appendectomy Complicated by Peritonitis

“…Approximately one-third of patients will require surgical intervention [4]. This case of TOA in a virginal 15year-old female status post appendectomy and peritonitis highlights the complexity of identifying a source of infection for TOA in adolescents.…”

“…TOA is an urgent issue that cannot be missed and requires prompt initiation of intravenous antibiotic therapy due to both short-term complications such as peritoneal spread and systemic inflammatory response progressing to sepsis and long-term complications like chronic pelvic pain and future infertility [ 3 ]. Empiric, broad-spectrum antibiotic therapy includes antibiotics active against gram-positive, gram-negative, and anaerobic microbes due to the often polymicrobial nature of TOA [ 4 ]. Approximately one-third of patients will require surgical intervention [ 4 ].…”

“…Empiric, broad-spectrum antibiotic therapy includes antibiotics active against gram-positive, gram-negative, and anaerobic microbes due to the often polymicrobial nature of TOA [ 4 ]. Approximately one-third of patients will require surgical intervention [ 4 ]. This case of TOA in a virginal 15-year-old female status post appendectomy and peritonitis highlights the complexity of identifying a source of infection for TOA in adolescents.…”

“…Cases of TOA from hematogenous spread of gastrointestinal pathology and subsequent seeding of ovarian tissues have been described in the literature but are exceedingly rare [ 4 ]. Given the timeline of acute appendicitis five months before the presentation of symptoms attributed to the TOA in our patient, it is possible but very unlikely that the TOA resulted from seeding of the peritoneum after the appendicitis and resulting peritonitis.…”

“…Close follow-up with a gynecologist is important in the setting of TOA. Ultrasound screening may be necessary after antibiotic treatment is complete to ensure resolution [ 4 ].…”