Large Douglas Abscess with Distinctive Bilateral Salpingitis in a Young Virginal Woman 6 Months Following Small Bowel Perforation at the Level of the Jejunojejunostomy After Roux-en-Y Gastric Bypass: A Case Report.

Publisher: Dove Medical Press Country of Publication: New Zealand NLM ID: 101531698 Publication Model: eCollection Cited Medium: Print ISSN: 1179-1411 (Print) Linking ISSN: 11791411 NLM ISO Abbreviation: Int J Womens Health Subsets: PubMed not MEDLINE

Original Publication: [Auckland, N.Z.] : Dove Medical Press, c2009-

Douglas abscesses (DA) involving the ovaries and/or fallopian tubes and tubo-ovarian abscesses (TOA) constitute a very rare finding in virginal females. Underlying conditions are suspected to play a role in their development; often however, the exact pathomechanism remains hypothetical or unknown. We report the case of a 19-year-old virginal female who was referred to our outpatient clinic for further clarification of a 6-month ongoing secondary amenorrhea. In the course of the investigations, a large Douglas abscess with distinctive bilateral salpingitis was diagnosed as an incidental finding in a basically oligosymptomatic patient. Laparoscopic abscess drainage was performed and appropriate antibiotic therapy administered. Intraoperatively collected specimens revealed Escherichia coli to be the responsible pathogen and detected foreign body giant cell reaction to intestinal contents on histopathological workup. Retrospectively, a small bowel perforation at the level of the jejunojejunostomy after Roux-en-Y gastric bypass with spillage of intestinal contents and positive cultures for Escherichia coli , 6 months prior to her referral, was identified as the triggering event. This case, however unique its pathomechanism may be, demonstrates that a history of intestinal leakage in the context of bowel surgery should be considered a relevant risk factor for the development of DA and TOA in virginal females, even if the primary cause lies several months in the past. It is under these circumstances that the clinical presentation can be atypical and misleading, making it all the more difficult to diagnose. Nonetheless, considering the possibility of this rare condition in light of medical history is crucial.
Competing Interests: The authors report no conflicts of interest in this work.
(© 2024 Verta et al.)

Eur J Pediatr Surg. 2004 Feb;14(1):70-2. (PMID: 15024685)
Obstet Gynecol. 1996 May;87(5 Pt 2):883. (PMID: 8677128)
Pediatr Int. 2012 Oct;54(5):706-9. (PMID: 23005903)
Infect Dis Clin North Am. 2008 Dec;22(4):693-708. (PMID: 18954759)
J Adolesc Health. 2019 Aug;65(2):303-305. (PMID: 31196784)
Obstet Gynecol Surv. 2009 Oct;64(10):681-9. (PMID: 19772677)
J Pediatr Adolesc Gynecol. 2010 Feb;23(1):e9-12. (PMID: 19682931)
Obstet Gynecol. 2000 Mar;95(3):397-402. (PMID: 10711551)
Int J STD AIDS. 2018 Feb;29(2):108-114. (PMID: 29198181)
J Pediatr Adolesc Gynecol. 2013 Aug;26(4):e99-102. (PMID: 23566794)
J Pediatr Adolesc Gynecol. 2009 Jun;22(3):e13-6. (PMID: 19539189)
J Pediatr Adolesc Gynecol. 2004 Oct;17(5):351-2. (PMID: 15581782)
BMC Womens Health. 2021 May 13;21(1):198. (PMID: 33985484)
Eur J Obstet Gynecol Reprod Biol. 2004 Jun 15;114(2):203-9. (PMID: 15140516)
J Pediatr Adolesc Gynecol. 2021 Jun;34(3):328-333. (PMID: 33340647)
Arch Pediatr Adolesc Med. 1999 Jan;153(1):91-2. (PMID: 9895008)
J Pediatr Adolesc Gynecol. 2017 Apr;30(2):203-208. (PMID: 26260586)

Keywords: Douglas abscess; Escherichia coli; Roux-en-Y gastric bypass; small bowel perforation; tubo-ovarian abscess; virginal female

Date Created: 20250101 Latest Revision: 20250104

20250104

PMC11687315

10.2147/IJWH.S492026

39742344