Postpartum tubo-ovarian abscess, likely arising from pelvic inflammatory disease during pregnancy

Description

A female aged 18 years presented 2 weeks postnormal vaginal delivery with worsening generalised abdominal pain radiating to the back since delivery, with associated night sweats. She was vomiting, had loose bowel motions and had difficulty passing urine, but denied dysuria. On examination, she was febrile, tachypnoeic and tachycardic, and had a pale complexion. Her abdomen was distended with maximal tenderness in the left illiac fossa and associated rebound and percussion tenderness. She was unable to pass urine in the emergency department. Blood tests demonstrated a raised white cell count, C reactive protein 344 and CA-125 145.

She had a CT abdomen which showed a large pelvic abscess (figure 1 and figure 2) with internal septations posterior to the uterus (figure 3) and bilateral hydronephrosis and hydroureter. She was given intravenous antibiotics and underwent a laparotomy with drainage of pelvic abscess. Intraoperative findings included...

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