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11/104. Unruptured pelvic abscesses in pregnancy: report of two cases.

    Pelvic abscess is a rare entity in pregnancy. The true etiology is uncertain but a flare-up of an old pelvic inflammatory disease is most likely. Usually, these patients undergo laparotomy and these abscesses are discovered incidentally, as described in our series. Surgical drainage and conservative surgical procedures under antibiotics are recommended during pregnancy albeit there is no consensus on patient management. Through this report, we aim to discuss this clinical entity and to underline the importance of patient management in case of its diagnosis.
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12/104. pseudomonas aeruginosa-infected IUD associated with pelvic inflammatory disease. A case report.

    BACKGROUND: While pelvic infection is known to be an infrequent complication of intrauterine device (IUD) use, infections are usually related to microorganisms introduced at the time of insertion or by sexual contact. CASE: We diagnosed a 35-year-old woman with an IUD for 6 years with pelvic inflammatory disease (PID) and implemented antibiotic therapy. Her clinical course worsened, and exploratory surgery revealed a right tuboovarian abscess with multiple loculated pelvic abscesses. culture of the IUD found heavy growth of pseudomonas aeruginosa. CONCLUSION: P aeruginosa has not previously been described in association with infections of the upper female genital tract. Double coverage with appropriate antipseudomonal agents is essential for proper treatment of pseudomonal infections.
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13/104. Actinomycotic tubo-ovarian abscess mimicking pelvic malignancy.

    A 39-year-old multipara was admitted to hospital with lower abdominal pain. She had used an intrauterine device (IUD) for 10 years. Three years ago, her tubes were ligated. Ultrasound examination revealed a 9.5 x 6 cm multiloculated cystic mass in the right part of her lower abdomen. CA-125 was also found to be increased. Since ovarian malignancy was suspected, laparotomy was performed. Pathologically, an actinomycotic tubo-ovarian abscess with sulfur granules was disclosed.
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14/104. Tuboovarian abscess caused by Atopobium vaginae following transvaginal oocyte recovery.

    A 39-year-old woman with tubarian sterility fell ill with acute pelvic inflammatory disease 2 months after transvaginal oocyte recovery. laparotomy revealed a large tuboovarian abscess, from which Atopobium vaginae, an anaerobic gram-positive coccoid bacterium of hitherto unknown clinical significance, was isolated. The microbial etiology and the risk of pelvic infections following transvaginal punctures are discussed.
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15/104. Brucella pelvic tubo-ovarian abscess mimicking a pelvic malignancy.

    A 57-y-old woman presented with recurrent abdominal and pelvic pain of 6 months' duration with low-grade fever. A computed tomographic scan indicated an ovarian tumor. laparotomy revealed a pelvic abscess. Her symptoms resolved following surgery and antibiotic therapy. pathology revealed an extensive inflammatory process. Tissue culture grew Brucella sp. The diagnosis and management of this previously undescribed pelvic tubo-ovarian abscess present a particular challenge.
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16/104. Ruptured tuboovarian abscess causing peritonitis in a postmenopausal woman. A difficult diagnosis on imaging.

    pelvic inflammatory disease with tuboovarian abscess is rare in postmenopausal women. Clinical and sonographic findings are usually sufficient to recognize pelvic inflammatory disease in premenopausal women, but in the elderly the disease may easily be overlooked, largely by unexpectedness. Computed tomography can be helpful when the clinical and sonographic findings are complex or equivocal. However, when the level of suspicion is low, it can be very difficult to interpret, especially when complicated with peritonitis, as illustrated in the present case report.
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17/104. Ruptured tubo-ovarian abscess as a complication of IVF treatment: clinical, ultrasonographic and histopathologic findings. A case report.

    Tuboovarian abscess is a rare complication of IVF treatment, which can be lethal on rupture. Hereby, we present a case of a ruptured tubo-ovarian abscess, following transvaginal ultrasound-guided oocyte retrieval for IVF and transcervical embryo trasfer in a 38-year-old white female patient with five years of primary infertility who underwent aspiration of bilateral hydrosalpinges at the time of oocyte retrieval. This case suggests that the reactivation of latent pelvic infection due to a previous pelvic inflammatory disease (PID) was the possible route of infection after transvaginal ultrasound-directed follicle aspiration--transcervical embryo transfer. We conclude that physicians should consider the diagnosis of tubo-ovarian abscess in the differential diagnosis of abdominal pain, fever and leukocytosis after ovum retrieval and transcervical embryo transfer for IVF treatment. Preservation of the uterus and unaffected uterine adnexa should be attempted in such cases if future pregnancy is desired.
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18/104. Neuropathic uterine pain after hysterectomy. A case report.

    BACKGROUND: Neuropathic pain arises when there is damage to or dysfunction of the nervous system. Diabetic neuropathy, postherpetic neuralgia and phantom limb pain are common types of neuropathic pain. It is not commonly recognized in gynecologic practice. CASE: A patient underwent a hysterectomy for a tuboovarian abscess and underlying endometriosis. Despite maximal dosing with conventional pain medications, she continued to have significant pain that had not been present following prior surgeries. Use of low-dose amitriptyline successfully treated the pain, with no sequelae. CONCLUSION: Persistent pain following gynecologic surgery that does not respond to conventional therapy may have a neuropathic origin. attention to appropriate history and physical examination may lead to an increase in the diagnosis of neuropathic pain in gynecology patients. This may have implications for persistent pain in other gynecologic diseases.
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19/104. Ovarian abscess due to brucella melitensis.

    The case of a 25-y-old woman with brucellar ovarian abscess is reported. Cultures of blood, ascites and a pus specimen yielded brucella melitensis. The possibility of ovarian abscess being caused by brucella melitensis should be considered in countries where the infection is endemic.
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20/104. Percutaneous catheter drainage of tubo-ovarian abscesses.

    We present the successful treatment of tubo-ovarian abscesses in three young patients by continuous percutaneous drainage, inserted under the guidance of real-time ultrasonography using only local anesthesia. Each patient had been diagnosed laparoscopically as suffering from acute pelvic inflammatory disease, but had formed abscesses despite extensive broad-spectrum antibiotic therapy. One case involved a complication of the ovum pick-up procedure; the woman had tubo-ovarian abscesses with infected hematomas. Because the abscesses were localized anteriorly in the lower abdomen and did not reach the pouch of Douglas, they could not be drained through a posterior colpotomy. Ultrasound guidance allowed us to drain all the areas of the multioculated abscesses. We suggest that percutaneous abscess drainage be the initial treatment of choice for tubo-ovarian abscesses before laparotomy is considered.
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