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Year : 2023  |  Volume : 28  |  Issue : 5  |  Page : 428-430

A rare case of premenarchal ovarian abscess presenting as an acute abdomen

Department of Paediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission08-Apr-2023
Date of Decision30-May-2023
Date of Acceptance31-May-2023
Date of Web Publication05-Sep-2023

Correspondence Address:
Enono Yhoshu
6th Floor, A Block, Department of Paediatric Surgery, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh - 249 203, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaps.jiaps_76_23

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Ovarian abscesses are usually seen in females of reproductive age group. They may occur secondary to urinary tract infections, pelvic inflammatory diseases, or gastrointestinal infections. They are uncommon in premenarchal females. They can be either managed conservatively with antibiotics and analgesics or may require surgery. In this case report, we present the case of a 6-year-old female who presented to us with an acute abdomen, which was diagnosed as a case of ovarian abscess and improved on exploration and drainage.

Keywords: Acute abdomen, children, ovarian abscess, premenarchal

How to cite this article:
Jagdish B, Yhoshu E, Sree BS, Sharma G, Menghwani H. A rare case of premenarchal ovarian abscess presenting as an acute abdomen. J Indian Assoc Pediatr Surg 2023;28:428-30

How to cite this URL:
Jagdish B, Yhoshu E, Sree BS, Sharma G, Menghwani H. A rare case of premenarchal ovarian abscess presenting as an acute abdomen. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Oct 2];28:428-30. Available from: https://www.jiaps.com/text.asp?2023/28/5/428/385151

   Introduction Top

Ovarian abscesses usually occur as a complication of pelvic inflammatory disease (PID) or as a result of an ascending genital tract infection. It was found that 2.3% of patients with PID had a tubo-ovarian abscess.[1] It is rare in premenarchal children and is common in sexually active women of reproductive age. In our review of the literature, we found only 4 premenarchal patients who had an ovarian abscess.

A female child presented to us with an acute abdomen subsequently found to be a case of a right ovarian abscess which resolved with exploration and drainage.

   Case Report Top

A 6-year-old female child presented to our emergency room with severe lower abdominal pain and nonbilious vomiting for 15 days and intermittent fever and burning micturition for 1 week. She was hemodynamically stable and her abdominal examination revealed a vague, tender, and nonmobile lump in the right iliac fossa. Hemogram showed a normal hemoglobin (11 g/dl) and leukocytosis (20,000 cells/mm3) and C-reactive protein (167 mg/L) was raised. Urine culture showed  Escherichia More Details coli sensitive to amikacin. Ultrasonography showed a heteroechoic solid cystic mass of size 6 cm × 4.7 cm in the right adnexa and the adjacent omentum was hyperechoic. The right ovary was not visualized separately and the left ovary appeared normal. Tumor markers were normal (beta-human chorionic gonadotropin <2 mIU/ml and alpha fetoprotein <1.3 ng/ml). A contrast-enhanced computed tomography of the abdomen and pelvis was done which showed a 5.5 cm × 5.5 cm, thick-walled hypodense lesion with underlying fluid and air pockets in the right adnexa suggestive of an inflammatory lesion likely adnexal origin [Figure 1]a. On exploration, right ovary was firm and cystic measuring about 5 cm × 7 cm, which on opening had internal septations and pus collection of about 40 ml. Pus was drained, abscess cavity and pelvis was washed and the abscess wall was sent for histopathological examination. A 24 Fr drain was placed in the abscess cavity [Figure 1]b. There was no separate mass in the right ovary. The left ovary, bilateral  Fallopian tube More Detailss, bladder, uterus, and bowel were normal. The patient was managed postoperatively with injection piperacillin-tazobactam, amikacin, and metronidazole. The drain was removed on postoperative day 2 after output reduced and she was discharged on postoperative day 4 in a satisfactory condition. Pus culture was sterile and CBNAAT was negative for Mycobacterium tuberculosis. Histopathology of the wall was consistent with features of an abscess and showed no evidence of malignancy or granuloma [Figure 1]c. The patient is on regular follow-ups and two repeat ultrasounds of the pelvis were done over 1 year which showed no residual collection and a normal right ovary.
Figure 1: (a) CECT showing thick-walled hypodense lesion with underlying fluid and air pockets in right adnexa; (b): Right ovarian abscess after debridement (arrow on abscess wall) with drain inside the cavity; (c): Section examined shows fibrocollagenous tissue showing large areas of necrosis (arrow), exhibiting karyorrhexis and sparse surrounding mixed inflammation. CECT: Contrast-enhanced computed tomography

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   Discussion Top

Ovarian abscess is uncommon in children and seen usually in sexually active females. The main cause is usually an ascending genital tract infection and PID.[1],[2],[3],[4],[5]

The patient may present with vague symptoms such as lower abdominal pain, fever, or dysuria. Predisposing factors in sexually inactive young girls include obesity, recurrent urinary tract infection, and poor hygiene.[2],[3] Fecal incontinence and gastrointestinal infection can be other factors.[3],[4] Few cases have been reported of premenarchal females with ovarian abscesses [Table 1].
Table 1: Literature review of previously reported cases of premenarchal tubo-ovarian abscesses

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Fei et al., 2021, in their case series of 10 children, mentioned that ovarian abscesses more than 8 cm had a higher chance of requiring surgery.[3] They also added that ovarian abscess can be managed with antibiotics, and if there is no resolution of symptoms in 48–72 h, patients should be considered for surgical intervention.[3] It is recommended that surgery should be reserved for complicated cases (sepsis, acute abdomen, and hemodynamically unstable).[4],[5] Laparoscopic diagnosis and drainage have been done in pediatric cases of tubo-ovarian abscess and were found to be effective.[2],[3],[7] However, there is not much literature on the management of children with ovarian abscesses. This child presented with complaints for about 15 days and with an acute abdomen, febrile episodes with burning micturition and hence exploration was done. Untreated ovarian abscesses have been seen to increase the risk of infertility, chronic pelvic pain, and ectopic pregnancies.[3],[4]

   Conclusion Top

Ovarian abscesses, though rare, can occur in children. It should be thought of when premenarchal females with an ovarian mass present with an acute abdomen. Timely drainage of abscess preserving the ovary can provide satisfactory relief for the patient and have an overall good outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Kairys N, Roepke C. Tubo-Ovarian Abscess. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.  Back to cited text no. 1
Hartmann KA, Lerand SJ, Jay MS. Tubo-ovarian abscess in virginal adolescents: Exposure of the underlying etiology. J Pediatr Adolesc Gynecol 2009;22:e13-6.  Back to cited text no. 2
Fei YF, Lawrence AE, McCracken KA. Tubo-ovarian abscess in non-sexually active adolescent girls: A case series and literature review. J Pediatr Adolesc Gynecol 2021;34:328-33.  Back to cited text no. 3
Goodwin K, Fleming N, Dumont T. Tubo-ovarian abscess in virginal adolescent females: A case report and review of the literature. J Pediatr Adolesc Gynecol 2013;26:e99-102.  Back to cited text no. 4
Arda IS, Ergeneli M, Coskun M, Hicsonmez A. Tubo-ovarian abscess in a sexually inactive adolescent patient. Eur J Pediatr Surg 2004;14:70-2.  Back to cited text no. 5
Sirotnak AP, Eppes SC, Klein JD. Tuboovarian abscess and peritonitis caused by Streptococcus pneumoniae serotype 1 in young girls. Clin Infect Dis 1996;22:993-6.  Back to cited text no. 6
Habek D, Vranko Nagy N, Sklebar I, Grabovac S, Cerkez Habek J. Rupture of coliform pyosalpinx in a nine-year old girl. Zentralbl Gynakol 2002;124:220-2.  Back to cited text no. 7


  [Figure 1]

  [Table 1]


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