Background:
When investigating and managing a female patient with a possible right sided pelvic abscess, one should always consider that both adnexal structures (fallopian tube and ovary), ureter and the appendix may be involved.
Discussion:
Complex adnexal masses present a diagnostic challenge at ultrasound and it may be impossible to identify which structures are involved. We present a case, with ultrasound images and video of laparoscopy, of a 42 year-old woman with a right sided adnexal mass. She presented with symptoms and signs consistent with both pelvic inflammatory disease and appendicitis. Ultrasound suggested a possible dermoid cyst. Laparoscopy, however, demonstrated a complex right sided pelvic abscess involving both adnexal structures, with the ureter adherent to them and to the appendix. An appendicectomy and right sided salpingo-oophorectomy were performed along with ureterolysis. On histopathology a periappendiceal abscess and acute salpingitis were shown with an aspirate growing mixed anaerobes and Streptococcus constellatus.
Conclusion:
This case reminds us that when a patient with a complex right sided adnexal mass and symptoms consistent with infection is surgically managed in an acute setting, careful dissection of the sidewall and ureterolysis should be performed, or one skilled to do so should be called upon to do it. One should also maintain a high suspicion for bowel pathology.