早期の腹腔鏡手術が治療に有用であった卵管卵巣膿瘍の一例

抄録

Background: Cases of tubo-ovarian abscess (TOA) may often be difficult to diagnose solely based on imaging findings. This report describes a case of a ruptured TOA that was successfully diagnosed and treated laparoscopically.

Case: A 42-year-old woman, gravida 3, para 3, presented to our hospital with a chief complaint of acute lower abdominal pain and vomiting. Upon admission, her vital signs were stable. Physical examination revealed rebound tenderness, at its maximum in the right lower abdomen. Blood tests showed a slight increase in the inflammatory response. Contrast-enhanced CT and MRI revealed a 4-cm cyst with fluid level formation in the right ovary. However, the possibility of torsion in the cyst could not be ruled out. Therefore, emergency laparoscopic surgery was performed for diagnosis and treatment. Intraoperative findings indicated a ruptured right ovary, enlarged to the size of a chicken egg, along with purulent ascites accumulated in the Douglas fossa. The patient was diagnosed with a ruptured ovarian abscess complicated by an endometrial cyst. A laparoscopic right salpingo-oophorectomy with intraperitoneal lavage was performed. Bacteroides fragilis was detected in the ascitic fluid, and blood cultures were obtained intraoperatively. The patient received a 14-day course of antibiotics and was discharged on the 15th postoperative day.

Conclusion: Early laparoscopic surgery is considered beneficial for the treatment of ruptured TOA.