A Tubo-Ovarian Abscess Caused by Salmonella enterica

Abstract

A tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), which is usually associated with polymicrobial infections, with a predominance of anaerobic bacteria. Salmonella species are rarely associated with TOA, as only 11 cases have been documented in the literature. We present the case of an 18-year-old virgin who contracted a Salmonella enterica (S. enterica)-induced TOA. After experiencing an episode of gastroenteritis 13 days earlier, attributed to chicken consumption, the patient revealed severe abdominal pain, fever, diarrhea and vomiting. A right adnexal mass was found by imaging, and symptoms continued even after starting broad-spectrum antibiotic treatment. For this reason, an exploratory laparotomy was considered crucial, and it confirmed a right TOA, necessitating surgical management, including a right salpingectomy and abscess drainage. Postoperative cultures identified S. enterica as the causative organism. The patient recovered uneventfully after targeted antibiotic therapy. A Salmonella-associated TOA was observed in a non-sexually active patient, with the most probable route of transmission being an ascending infection following recent gastroenteritis. No underlying gynecological pathology was found. Since unspecific symptoms of TOA might imitate those of other acute abdominal disorders, this article emphasizes the difficulties in diagnosing this pathology in sexually inactive patients. Including rare pathogens such as Salmonella species in the differential diagnosis of TOA is essential. Early recognition, combined with appropriate surgical treatment, is critical for a successful outcome if conservative management fails.