Tubo-ovarian abscess in non sexually active adolescents

Pelvic inflammatory disease in the adolescent and young adult: An update

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).

Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature

Background

Ovarian abscesses, which occur mostly in sexually active women via recurrent salpingitis, occur rarely in virginal adolescent girls. Here, we present a case of an ovarian abscess in a virginal adolescent girl who was diagnosed and treated by laparoscopy.

Case presentation

A 13-year-old healthy girl presented with fever lasting for a month without abdominal pain. Computed tomography scan and magnetic resonance imaging indicated a right ovarian abscess. Laparoscopic surgery revealed a right ovarian abscess with intact uterus and fallopian tubes. The abscess was caused by Staphylococcus aureus. The patient recovered completely after excision of the abscess, followed by antibiotic treatment.

Conclusions

Ovarian abscess may occur in virginal adolescent girls; Staphylococcus aureus, an uncommon species causing ovarian abscess, may cause the infection.

Tubo-Ovarian Abscess in a Virginal Adolescent with Labial Agglutination Due to Lichen Sclerosus

BACKGROUND

We describe an unusual presentation of lichen sclerosus in a postmenarchal, virginal girl.

CASE

A 14-year-old girl first presented with acute urinary retention due to labial agglutination and developed bilateral tubo-ovarian abscesses in 10 days of the conservative management period. Abscesses were treated with antibiotherapy and percutaneous drainage; simple division of the labial agglutination and vulvar biopsies were performed with a preliminary diagnosis of lichen sclerosus. Postoperative follow-up with antibiotherapy and clobetasol propionate 0.05% ointment was uneventful.

SUMMARY AND CONCLUSION

Lichen sclerosus should be considered in cases of labial agglutination with atypical presentations. Finally, this case reminds us that pelvic inflammatory disease and tubo-ovarian abscess must be kept in mind even in virginal adolescents, especially in the presence of obstructive lesions of the genital tract.