Concurrent Acute Cystitis, Pancolitis, and Tubo-Ovarian Abscess Following Laparoscopic Ovarian Cystectomy: A Case Report

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Owda, Basil J. Zaid, Seema Hameedi, Liza Saadeddin, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4694029/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Sep, 2024 Read the published version in BMC Women's Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background Inadequate surgical interventions can lead to serious complications such as tubo-ovarian abscesses in the upper female genital system, often resulting from untreated pelvic inflammatory disease. Pelvic inflammatory disease, caused by infections like Chlamydia trachomatis and Neisseria gonorrhoeae , leads to scarring and adhesions in the reproductive organs, with common risk factors including intrauterine device use and multiple sexual partners. Pelvic inflammatory disease primarily affects sexually active young women and can manifest with varied symptoms, potentially leading to complications like ectopic pregnancy, infertility, and chronic pelvic pain if untreated. Case presentation This case report presents a unique scenario involving a 17-year-old sexually inactive female who experienced concurrent tubo-ovarian abscess, acute cystitis, and pancolitis following laparoscopic ovarian cystectomy. Pelvic inflammatory disease and its complications are well-documented, but the simultaneous occurrence of acute cystitis and pancolitis in this context is unprecedented in the medical literature. The patient’s presentation, clinical course, and management are detailed, highlighting the importance of considering diverse and severe complications in individuals with a history of gynecological surgeries. Conclusions Our case report highlights the need for healthcare professionals to remain vigilant for atypical presentations of gynecological complications and emphasizes the value of interdisciplinary collaboration for optimal patient care. We encourage further research and awareness to enhance understanding and recognition of complex clinical scenarios associated with gynecological procedures. pelvic inflammatory disease gynecological surgeries pancolitis acute cystits tubo-ovarian abscess Figures Figure 1 Background Inadequate surgical interventions can lead to serious complications, and tubo-ovarian abscesses exemplify such complications within the upper female genital system. These abscesses, characterized by fimbrial occlusion, intratubal pus accumulation, and enlargement of the fallopian tubes, can occur de novo or result from untreated or inadequately treated pelvic inflammatory disease (PID) ( 1 ). PID, an ascending polymicrobial infection of the upper female genital system, is frequently attributed to Chlamydia trachomatis and Neisseria gonorrhoeae . The condition induces alterations and impairments in the upper female genital system, predominantly through scarring and adhesion formation in reproductive structures like the endometrium, fallopian tubes, and ovaries. Common risk factors encompass intrauterine device implantation, tubal ligation, multiple sexual partners, and a history of previous PID. Primarily affecting sexually active young females, particularly in late adolescence and early adulthood, PID manifests with diverse symptoms, ranging from asymptomatic cases to vaginal discharge, bleeding, lower abdominal or pelvic pain, uterine or adnexal tenderness, and even sepsis. Unfortunately, healthcare professionals often overlook PID, leading to severe sequelae such as ectopic pregnancy, infertility, and chronic pelvic pain ( 2 ). Involvement of adjacent pelvic organs, particularly intra-abdominal structures, is an infrequent occurrence and typically manifests in atypical disseminated PID infections. Transmission primarily occurs through the lymphatic and hematologic routes. An instance of this organ involvement is the onset of cystitis, characterized by symptoms like urinary frequency, urgency, dysuria, hematuria, and suprapubic pain. Intriguingly, intra-abdominal dissemination has been associated with the emergence of intestinal obstruction, attributed to the organization of fibrous tissues and adhesions following surgical interventions ( 3 , 4 ). Ovarian cysts are benign fluid-filled ovarian spaces that manifest in about 5–15% of females during their reproductive ages. Patients are mainly asymptomatic but may present with pelvic pain or menstrual irregularities. Regardless, excision of ovarian cysts is crucial due to the potential for cyst rupture, hemorrhage, or torsion. Fortunately, minimally invasive surgical interventions, such as laparoscopic ovarian cystectomy, have become the gold standard approach for managing ovarian cysts. However, it is crucial to emphasize that the ovarian reserve post-surgery may decline ( 5 , 6 ). Herein, we report a 17-year-old sexually inactive female who had previously undergone a laparoscopic ovarian cystectomy and presented with a tubo-ovarian abscess with concurrent acute cystitis and pancolitis. Case presentation A 17-year-old female patient presented to our emergency department due to sudden, diffuse, and colicky abdominal pain lasting for four days. The pain coincided with non-bloody diarrhea and a decrease in appetite. Additionally, she reported associated symptoms such as nausea, feverish sensations, and chills. Later in her course, she complained of hematuria and dysuria. She denied any recent upper respiratory tract infections, contact with ill individuals, antibiotic intake, hesitancy, or abnormal vaginal discharge. Notably, she is a single adolescent with regular and smooth menstrual periods, having experienced menarche at the age of 10. Six months prior, she underwent a laparoscopic ovarian cystectomy due to the presence of a left ovarian cystadenofibroma due to a two-year-long and persistent mild nausea, anorexia, and occasional dizziness, with no associated menstrual irregularities. Pathological reports indicated that the 19 x 12 x 24 cm cyst showed no signs of malignancy. Upon examination, the patient was conscious and cooperative but appeared ill. All vital signs were stable. A comprehensive abdominal examination indicated a soft-lax abdomen with mild generalized tenderness, absent masses or rebound tenderness, and a tympanic abdomen upon percussion. The laboratory results elevated white blood cells (11.3 x10^9 cells/L; normal range: 4.2–10.8 x10^9 cells/L) and an elevated C-reactive protein level (6.04 mg/dL; normal range: <0.5 mg/dL),while the urine analysis showed many red blood cells. Her laboratory studies were otherwise unremarkable. An abdominal computed tomography (CT) scan confirmed the presence of concurrent tubo-ovarian abscess (Fig. 1 A), cystitis (Fig. 1 B), and acute pancolitis (Fig. 1 C). Consequently, the patient was admitted to the ward and was initiated on IV ampicillin (3g/day), clindamycin (18g), gentamicin (240 g/day), and acetaminophen (4g/day). One week later, she was discharged and was instructed in regards to follow-up appointments These follow-ups were deemed crucial for monitoring her recovery and ensuring the effectiveness of the treatment regimen. Discussion and conclusioms Tubo-ovarian abscesses, linked to pelvic inflammatory disease, arise from the ascent of lower genital tract pathogens. CT scans reveal fluid-filled masses with thick walls in the adnexa, accompanied by symptoms like fever, elevated white blood cell count, abdominopelvic pain, and potential discharge. Rupture poses a risk of sepsis. Early diagnosis is crucial for sexually active females, often treated with antibiotics. Adherence to Centers for Disease Control and Prevention's 2002 sexually transmitted disease (STD) guidelines led to a significant decline in prevalence to 2.3%, highlighting the importance of guideline compliance in preventing complications ( 7 ). In extremely severe cases, pelvic inflammatory disease may manifest with unusual and rare complications involving intra-abdominal organs. Martín-Lagos Maldonado et al. described a 24-year-old woman who presented with a tubo-ovarian abscess and intestinal obstruction due to pelvic inflammatory disease, necessitating exploratory laparoscopy, salpingectomy, abscess drainage, and ileal resection ( 3 ). Abul-Khoudoud et al. reported a case of Fitz-Hugh-Curtis syndrome. The patient, a 51-year-old woman with a history of pelvic inflammatory disease and tubal ligation, was initially diagnosed with biliary colic. However, during laparoscopic cholecystectomy, she was found to have mechanical small bowel obstruction ( 8 ). Harel et al. documented a 19-year-old patient with pelvic inflammatory disease experiencing high-grade partial small bowel obstruction, which resolved after conservative management ( 9 ). Haumann et al. described a 27-year-old woman diagnosed with pelvic inflammatory disease through laparoscopy after presenting with acute abdominal symptoms ( 10 ). These cases highlight the diverse and potentially severe complications associated with pelvic inflammatory disease, emphasizing the importance of prompt diagnosis and appropriate management. Our report details a rare case of multiple complications following laparoscopic ovarian cystectomy in a sexually inactive 17-year-old female. It highlights the importance of recognizing severe complications in such patients, even without typical risk factors. Timely diagnosis and treatment are crucial for preventing life-threatening outcomes and preserving reproductive health. This underscores the need for ongoing research and heightened awareness among healthcare professionals regarding diverse presentations of pelvic inflammatory disease. List Of Abbreviations Pelvic inflammatory disease (PID) Computed tomography (CT) Sexually transmitted disease (STD) Declarations Ethics approval and consent to participate Publishing of case reports in Palestine is not required to undergo any ethical approval by a committee; consent from patients is enough. Consent for publication Written consent was obtained from the patient’s parents to publish the case. Availability of data and materials All data for the case report are available in this manuscript. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors’ contributions YH, AO, and BZ partook in the writing of all sections of the case report. SH and LS gathered the patient’s data and partook in the writing of the case presentation. MA was responsible for writing and interpreting the radiological images. All authors read and approved the final manuscript. Acknowledgments We would like to thank the patient and her parents for their cooperation in the publication of this case report. References Sendy S, Abuy A, Sendy W, Baradwan S. Unusual presentation of bilateral pyosalpinx mimicking an ovarian torsion: A case report. Ann Med Surg [Internet]. 2020;52:16–8. https://www.sciencedirect.com/science/article/pii/S2049080120300169 . Frock-Welnak DN, Tam J. Identification and Treatment of Acute Pelvic Inflammatory Disease and Associated Sequelae. Obstet Gynecol Clin North Am. 2022;49(3):551–79. Martín-Lagos Maldonado A, Gallart Aragón T. Porcel Marin M del C. Pelvic inflammatory disease: An unusual cause of acute intestinal obstruction. Gastroenterol y Hepatol (English Ed [Internet]. 2019;42(9):549–50. https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition--382-articulo-pelvic-inflammatory-disease-an-unusual-S2444382419302159 . Nace DA, Perera SK, Hanlon JT, Saracco S, Anderson G, Schweon SJ, et al. The Improving Outcomes of UTI Management in Long-Term Care Project (IOU) Consensus Guidelines for the Diagnosis of Uncomplicated Cystitis in Nursing Home Residents. J Am Med Dir Assoc. 2018;19(9):765–e7693. Özcan R, Tekant GT. Ovarian Cyst. Pediatr Surg Dig Second Ed [Internet]. 2023 Jun 5 [cited 2024 Jan 9];527–8. https://www.ncbi.nlm.nih.gov/books/NBK560541/ . Mansouri G, Safinataj M, Shahesmaeili A, Allahqoli L, Salehiniya H, Alkatout I. Effect of laparoscopic cystectomy on ovarian reserve in patients with ovarian cyst. Front Endocrinol (Lausanne). 2022;13:964229. Munro K, Gharaibeh A, Nagabushanam S, Martin C. Diagnosis and management of tubo-ovarian abscesses. Obstet Gynaecol [Internet]. 2018;20(1):11–9. https://doi.org/10.1111/tog.12447 . Abul-Khoudoud OR, Khabbaz AY, Butcher CH, Farha MJ. Mechanical Partial Small Bowel Obstruction in a Patient with Fitz-Hugh-Curtis Syndrome. J Laparoendosc Adv Surg Tech [Internet]. 2001;11(2):111–4. https://doi.org/10.1089/109264201750162437 . Harel Z, Tracy TF Jr, Bussey IIIJG. Small Bowel Obstruction in an Adolescent with Pelvic Inflammatory Disease due to Chlamydia Trachomatis. J Pediatr Adolesc Gynecol [Internet]. 2003;16(3):125–8. https://doi.org/10.1016/S1083-3188(03)00041-X . Haumann A, Ongaro S, Detry O, Meunier P, Meurisse M. Acute pelvic inflammatory disease as a rare cause of acute small bowel obstruction. Acta Chir Belg [Internet]. 2019;119(5):328–30. https://doi.org/10.1080/00015458.2018.1453438 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Sep, 2024 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 10 Jul, 2024 Editor assigned by journal 08 Jul, 2024 Submission checks completed at journal 08 Jul, 2024 First submitted to journal 05 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4694029","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":325329475,"identity":"94881c46-3ad7-4905-82e2-af068a48818d","order_by":0,"name":"Yazan AlHabil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYPACiwQGCcbGAx+ATDZ24rRIgLQ0HJwB0sJMvBYGhsM8IDYhLQbHjz/8XFAjkcc/u7nhsM2vbfJ8zAyMHz7m4NFyJiFZesYxiWKJOwcbDuf23TZsY2Zglpy5DY+WAwkHpHnYJBIbbiQCtfTcZgRqYWPmxafl/MPm3zz/JBLng7RY9ty2J6zlRjKbNG+bROIGkBaGH7cTCWqRvPGMzZq3TyJxI9AvB3sbbie3MTM24/UL3/n0x7d5vtkkzrvd/vDBjz+3bee3Nx/88BGPFoUDyDzGNjDZgFs9EMijSv/Bq3gUjIJRMApGKAAAxO1aH+gNq0sAAAAASUVORK5CYII=","orcid":"","institution":"An-Najah National University","correspondingAuthor":true,"prefix":"","firstName":"Yazan","middleName":"","lastName":"AlHabil","suffix":""},{"id":325329476,"identity":"625c7206-f492-4caf-af2d-eb51b1720e1c","order_by":1,"name":"Anas N. Owda","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Anas","middleName":"N.","lastName":"Owda","suffix":""},{"id":325329477,"identity":"a7998b0e-56c3-4171-a6e7-323516d65089","order_by":2,"name":"Basil J. Zaid","email":"","orcid":"","institution":"H-Clinic Specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Basil","middleName":"J.","lastName":"Zaid","suffix":""},{"id":325329478,"identity":"6e7b04cd-29ec-453e-be48-5c2fa4d6bca3","order_by":3,"name":"Seema Hameedi","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Seema","middleName":"","lastName":"Hameedi","suffix":""},{"id":325329479,"identity":"deb36659-3ed9-4630-9b70-fb036e5e272e","order_by":4,"name":"Liza Saadeddin","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Liza","middleName":"","lastName":"Saadeddin","suffix":""},{"id":325329480,"identity":"aa1282fe-1b05-4f9a-b1e3-a8423ff9807f","order_by":5,"name":"Mohammad A.A. Awad","email":"","orcid":"","institution":"H-Clinic Specialty Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"A.A.","lastName":"Awad","suffix":""}],"badges":[],"createdAt":"2024-07-05 19:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4694029/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4694029/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-024-03341-3","type":"published","date":"2024-09-04T16:08:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62136552,"identity":"876a4d1f-e18f-41c6-8b0e-5419f2372e33","added_by":"auto","created_at":"2024-08-09 16:27:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1449883,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAbdominopelvic computed tomography scans suggesting a left tubo-ovarian abscess, acute cystitis, and acute pancolitis, respectively.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Axial view abdominopelvic computed tomography scan displaying a complex tubular multilocular enhancing structure in the left adnexa associated with regional fat stranding within the pelvis as well as a small volume of pelvic free fluid (blue arrow). These findings are suggestive of a left tubo-ovarian abscess; (B) Axial view abdominopelvic computed tomography scan displaying diffuse marked thickening throughout the urinary bladder wall associated with increased wall enhancement (blue arrows). These findings are suggestive of acute cystitis; (C) Axial view abdominopelvic computed tomography scan displaying a part of the transverse colon with wall thickening associated with increased mural enhancement and congested vasculature (blue arrows). These findings are seen throughout the entire colon and are suggestive of acute pancolitis.\u003c/p\u003e","description":"","filename":"Figure1ABC.png","url":"https://assets-eu.researchsquare.com/files/rs-4694029/v1/bf0344f530cff29ce72f0e7f.png"},{"id":64186369,"identity":"ecedb09a-ea4f-4bd2-984d-96f5cd143dc3","added_by":"auto","created_at":"2024-09-09 16:27:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1710629,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4694029/v1/f9683dbd-6598-4824-8424-44a97ac9aa45.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Concurrent Acute Cystitis, Pancolitis, and Tubo-Ovarian Abscess Following Laparoscopic Ovarian Cystectomy: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eInadequate surgical interventions can lead to serious complications, and tubo-ovarian abscesses exemplify such complications within the upper female genital system. These abscesses, characterized by fimbrial occlusion, intratubal pus accumulation, and enlargement of the fallopian tubes, can occur \u003cem\u003ede novo\u003c/em\u003e or result from untreated or inadequately treated pelvic inflammatory disease (PID) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePID, an ascending polymicrobial infection of the upper female genital system, is frequently attributed to \u003cem\u003eChlamydia trachomatis\u003c/em\u003e and \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e. The condition induces alterations and impairments in the upper female genital system, predominantly through scarring and adhesion formation in reproductive structures like the endometrium, fallopian tubes, and ovaries. Common risk factors encompass intrauterine device implantation, tubal ligation, multiple sexual partners, and a history of previous PID. Primarily affecting sexually active young females, particularly in late adolescence and early adulthood, PID manifests with diverse symptoms, ranging from asymptomatic cases to vaginal discharge, bleeding, lower abdominal or pelvic pain, uterine or adnexal tenderness, and even sepsis. Unfortunately, healthcare professionals often overlook PID, leading to severe sequelae such as ectopic pregnancy, infertility, and chronic pelvic pain (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInvolvement of adjacent pelvic organs, particularly intra-abdominal structures, is an infrequent occurrence and typically manifests in atypical disseminated PID infections. Transmission primarily occurs through the lymphatic and hematologic routes. An instance of this organ involvement is the onset of cystitis, characterized by symptoms like urinary frequency, urgency, dysuria, hematuria, and suprapubic pain. Intriguingly, intra-abdominal dissemination has been associated with the emergence of intestinal obstruction, attributed to the organization of fibrous tissues and adhesions following surgical interventions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOvarian cysts are benign fluid-filled ovarian spaces that manifest in about 5\u0026ndash;15% of females during their reproductive ages. Patients are mainly asymptomatic but may present with pelvic pain or menstrual irregularities. Regardless, excision of ovarian cysts is crucial due to the potential for cyst rupture, hemorrhage, or torsion. Fortunately, minimally invasive surgical interventions, such as laparoscopic ovarian cystectomy, have become the gold standard approach for managing ovarian cysts. However, it is crucial to emphasize that the ovarian reserve post-surgery may decline (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHerein, we report a 17-year-old sexually inactive female who had previously undergone a laparoscopic ovarian cystectomy and presented with a tubo-ovarian abscess with concurrent acute cystitis and pancolitis.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 17-year-old female patient presented to our emergency department due to sudden, diffuse, and colicky abdominal pain lasting for four days. The pain coincided with non-bloody diarrhea and a decrease in appetite. Additionally, she reported associated symptoms such as nausea, feverish sensations, and chills. Later in her course, she complained of hematuria and dysuria. She denied any recent upper respiratory tract infections, contact with ill individuals, antibiotic intake, hesitancy, or abnormal vaginal discharge. Notably, she is a single adolescent with regular and smooth menstrual periods, having experienced menarche at the age of 10.\u003c/p\u003e \u003cp\u003eSix months prior, she underwent a laparoscopic ovarian cystectomy due to the presence of a left ovarian cystadenofibroma due to a two-year-long and persistent mild nausea, anorexia, and occasional dizziness, with no associated menstrual irregularities. Pathological reports indicated that the 19 x 12 x 24 cm cyst showed no signs of malignancy.\u003c/p\u003e \u003cp\u003eUpon examination, the patient was conscious and cooperative but appeared ill. All vital signs were stable. A comprehensive abdominal examination indicated a soft-lax abdomen with mild generalized tenderness, absent masses or rebound tenderness, and a tympanic abdomen upon percussion.\u003c/p\u003e \u003cp\u003eThe laboratory results elevated white blood cells (11.3 x10^9 cells/L; normal range: 4.2\u0026ndash;10.8 x10^9 cells/L) and an elevated C-reactive protein level (6.04 mg/dL; normal range: \u0026lt;0.5 mg/dL),while the urine analysis showed many red blood cells. Her laboratory studies were otherwise unremarkable. An abdominal computed tomography (CT) scan confirmed the presence of concurrent tubo-ovarian abscess (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA), cystitis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB), and acute pancolitis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003eConsequently, the patient was admitted to the ward and was initiated on IV ampicillin (3g/day), clindamycin (18g), gentamicin (240 g/day), and acetaminophen (4g/day). One week later, she was discharged and was instructed in regards to follow-up appointments These follow-ups were deemed crucial for monitoring her recovery and ensuring the effectiveness of the treatment regimen.\u003c/p\u003e"},{"header":"Discussion and conclusioms","content":"\u003cp\u003eTubo-ovarian abscesses, linked to pelvic inflammatory disease, arise from the ascent of lower genital tract pathogens. CT scans reveal fluid-filled masses with thick walls in the adnexa, accompanied by symptoms like fever, elevated white blood cell count, abdominopelvic pain, and potential discharge. Rupture poses a risk of sepsis. Early diagnosis is crucial for sexually active females, often treated with antibiotics. Adherence to Centers for Disease Control and Prevention's 2002 sexually transmitted disease (STD) guidelines led to a significant decline in prevalence to 2.3%, highlighting the importance of guideline compliance in preventing complications (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn extremely severe cases, pelvic inflammatory disease may manifest with unusual and rare complications involving intra-abdominal organs. Mart\u0026iacute;n-Lagos Maldonado et al. described a 24-year-old woman who presented with a tubo-ovarian abscess and intestinal obstruction due to pelvic inflammatory disease, necessitating exploratory laparoscopy, salpingectomy, abscess drainage, and ileal resection (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Abul-Khoudoud et al. reported a case of Fitz-Hugh-Curtis syndrome. The patient, a 51-year-old woman with a history of pelvic inflammatory disease and tubal ligation, was initially diagnosed with biliary colic. However, during laparoscopic cholecystectomy, she was found to have mechanical small bowel obstruction (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Harel et al. documented a 19-year-old patient with pelvic inflammatory disease experiencing high-grade partial small bowel obstruction, which resolved after conservative management (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Haumann et al. described a 27-year-old woman diagnosed with pelvic inflammatory disease through laparoscopy after presenting with acute abdominal symptoms (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These cases highlight the diverse and potentially severe complications associated with pelvic inflammatory disease, emphasizing the importance of prompt diagnosis and appropriate management.\u003c/p\u003e \u003cp\u003eOur report details a rare case of multiple complications following laparoscopic ovarian cystectomy in a sexually inactive 17-year-old female. It highlights the importance of recognizing severe complications in such patients, even without typical risk factors. Timely diagnosis and treatment are crucial for preventing life-threatening outcomes and preserving reproductive health. This underscores the need for ongoing research and heightened awareness among healthcare professionals regarding diverse presentations of pelvic inflammatory disease.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003ePelvic inflammatory disease (PID)\u003c/p\u003e\n\u003cp\u003eComputed tomography (CT)\u003c/p\u003e\n\u003cp\u003eSexually transmitted disease (STD)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePublishing of case reports in Palestine is not required to undergo any ethical approval by a committee; consent from patients is enough.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent was obtained from the patient\u0026rsquo;s parents to publish the case.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data for the case report are available in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYH, AO, and BZ partook in the writing of all sections of the case report. SH and LS gathered the patient\u0026rsquo;s data and partook in the writing of the case presentation. MA was responsible for writing and interpreting the radiological images. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the patient and her parents for their cooperation in the publication of this case report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSendy S, Abuy A, Sendy W, Baradwan S. Unusual presentation of bilateral pyosalpinx mimicking an ovarian torsion: A case report. 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Small Bowel Obstruction in an Adolescent with Pelvic Inflammatory Disease due to Chlamydia Trachomatis. J Pediatr Adolesc Gynecol [Internet]. 2003;16(3):125\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1083-3188(03)00041-X\u003c/span\u003e\u003cspan address=\"10.1016/S1083-3188(03)00041-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaumann A, Ongaro S, Detry O, Meunier P, Meurisse M. Acute pelvic inflammatory disease as a rare cause of acute small bowel obstruction. Acta Chir Belg [Internet]. 2019;119(5):328\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00015458.2018.1453438\u003c/span\u003e\u003cspan address=\"10.1080/00015458.2018.1453438\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"pelvic inflammatory disease, gynecological surgeries, pancolitis, acute cystits, tubo-ovarian abscess","lastPublishedDoi":"10.21203/rs.3.rs-4694029/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4694029/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eInadequate surgical interventions can lead to serious complications such as tubo-ovarian abscesses in the upper female genital system, often resulting from untreated pelvic inflammatory disease. Pelvic inflammatory disease, caused by infections like \u003cem\u003eChlamydia trachomatis\u003c/em\u003e and \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e, leads to scarring and adhesions in the reproductive organs, with common risk factors including intrauterine device use and multiple sexual partners. Pelvic inflammatory disease primarily affects sexually active young women and can manifest with varied symptoms, potentially leading to complications like ectopic pregnancy, infertility, and chronic pelvic pain if untreated.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eThis case report presents a unique scenario involving a 17-year-old sexually inactive female who experienced concurrent tubo-ovarian abscess, acute cystitis, and pancolitis following laparoscopic ovarian cystectomy. Pelvic inflammatory disease and its complications are well-documented, but the simultaneous occurrence of acute cystitis and pancolitis in this context is unprecedented in the medical literature. The patient\u0026rsquo;s presentation, clinical course, and management are detailed, highlighting the importance of considering diverse and severe complications in individuals with a history of gynecological surgeries.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur case report highlights the need for healthcare professionals to remain vigilant for atypical presentations of gynecological complications and emphasizes the value of interdisciplinary collaboration for optimal patient care. We encourage further research and awareness to enhance understanding and recognition of complex clinical scenarios associated with gynecological procedures.\u003c/p\u003e","manuscriptTitle":"Concurrent Acute Cystitis, Pancolitis, and Tubo-Ovarian Abscess Following Laparoscopic Ovarian Cystectomy: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 16:27:18","doi":"10.21203/rs.3.rs-4694029/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-10T17:53:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-08T06:07:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-08T06:06:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-07-05T19:46:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ceb923f-e7ac-49e3-8422-c685e310a4dc","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:20:46+00:00","versionOfRecord":{"articleIdentity":"rs-4694029","link":"https://doi.org/10.1186/s12905-024-03341-3","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2024-09-04 16:08:25","publishedOnDateReadable":"September 4th, 2024"},"versionCreatedAt":"2024-08-09 16:27:18","video":"","vorDoi":"10.1186/s12905-024-03341-3","vorDoiUrl":"https://doi.org/10.1186/s12905-024-03341-3","workflowStages":[]},"version":"v1","identity":"rs-4694029","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4694029","identity":"rs-4694029","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}