Rupture of a tuboovarian abscess is a life-threatening emergency. The current standard of care is surgery to manage the onset of peritonitis and sepsis.A 34-year-old woman presented with gradually worsening abdominal pain over several weeks. She had fever, pelvic tenderness, an elevated white blood cell count and ultrasonographic evidence of a tuboovarian abscess. After 48 hours of triple antibiotic therapy without a clinical improvement, she underwent surgery, during which she was found to have an abscess that had ruptured into the abdominal wall. A supracervical hysterectomy/bilateral salpingo-oophorectomy and surgical debridement of the subcutaneous tissue was performed, with wet to dry dressing changes of the surgical wound. Over the following 18 months, the patient required extensive wound care for recurrent bouts of wound drainage.Rupture of a tuboovarian abscess usually presents with sudden worsening of the patient's condition. Delays in surgical debridement and drainage increase the rate of associated mortality. Atypical presentations may present as cases resistant to conventional medical therapy, with fewer of the associated risks of life-threatening peritonitis and subsequent sepsis. Our patient represents the first reported case of extraperitoneal spillage of abscess contents from rupture of a tuboovarian abscess into the anterior abdominal wall.
In Brief The transobturator tape (TOT) is gaining popularity as a new method of treatment of women with stress urinary incontinence. It is a minimally invasive procedure that is effective with low intraoperative rates. In our series, 13 consecutive women were operated using the TOT ObTape. Consequently, 4 cases (31%) of delayed vaginal wall erosions were noted months after surgery in our patients. All erosions were located in the midline at the central part of the vaginal incision. Histologic evaluation suggested poor tissue ingrowth and chronic local infection. Furthermore, all patients failed conservative management and required surgical exploration and resection of the exposed tape. Further investigation is warranted to evaluate this unacceptably high vaginal erosion rate with ObTape found in our series. The use of ObTape was associated with an unacceptably high delayed vaginal erosion rate.
