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A case-report on diverticulitis misdiagnosed as tubo-ovarian abscess

ABSTRACT:

Introduction and importance

Tubo-ovarian abscesses (TOA) is presented with multiple clinical manifestations including gastrointestinal findings.

Case presentation

Herein, we present a case of complicated diverticulitis that was misdiagnosed as TOA, owing to overlapping genital involvement.

Clinical discussion

Imaging could be misleading in these patients as a result of severe inflammation of intestines and surrounding organs.

Conclusion

Patients who do not respond to antibiotic treatment should be suspected of other gastrointestinal pathologies such as diverticulitis and should be evaluated accordingly. Highlights • Concomitant presentation of diverticulitis and Tubo-ovarian abscesses (TOA) has been rarely reported.• Diverticulitis can also be complicated, indicated by the involvement of other organs such as ovaries and fallopian tube.• In such cases, pathological evaluation, following the surgical intervention can indicate the exact disease.

SUBMITTER: Kazemi S

PROVIDER: S-EPMC8593559 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundMelioidosis, the disease caused by Burkholderia pseudomallei is endemic in the Northeastern part of Thailand, South-East Asia, and Northern Australia. The pelvic involvement of disease is rare even in an endemic area. Therefore, we describe in this report the clinical presentation, management, and outcome of the patient with primary tubo-ovarian abscess due to melioidosis.Case presentationA 31-year-old Thai cassava farmer woman presented with fever and abdominal pain at left lower quadrant for one month. She also had pain, swelling, and redness of the genitalia without any ulcer. She had odorless whitish vaginal discharge. The pelvic examination revealed excitation pain on the left side of her cervix. Transvaginal ultrasonography revealed a large left tubo-ovarian abscess size 9.4 × 4.8 cm located at anterior of the uterus. Urgent exploratory laparotomy revealed left hydrosalpinx with a large amount of pus. The pus culture grew Burkholderia pseudomallei. The computer tomography of the abdomen revealed multiple hepatosplenic abscesses. The patient underwent left salpingo-oophorectomy and pus drainage. The pathological examination of excised left adnexa revealed chronic and acute suppurative inflammation with necrotic tissue. She was given intravenous ceftazidime for one month, and her clinical symptom improved. She was diagnosed with type 2 diabetes mellitus at this visit and treated with insulin injection. She continued to take oral co-trimoxazole for 20 weeks. The final diagnosis was disseminated melioidosis with left tubo-ovarian abscess and hepatosplenic abscesses in a newly diagnosed morbidly obese diabetic patient.ConclusionBurkholderia pseudomallei should be considered as the causative organism of gynecologic infection among patient with risk factor resided in an endemic area who do not respond to standard antibiotics. The pus culture from the site of infection is the only diagnostic method of pelvic melioidosis, appropriate antibiotics, and adequate surgical drainage were the components of the successful outcome.