A case of periodic abdominal pain and fever due to left ovarian abscess.

Tubo-ovarian abscess (TOA) is a late complication of pelvic inflammatory disease. Its diagnosis is difficult because it is occasionally accompanied by atypical symptoms such as abdominal pain and fever. A 45-year-old married woman presented with recurrent abdominal pain and fever. Her medical history included ovarian surgery 14 years prior to presentation. Computed tomography (CT) performed by her local doctor confirmed uterine fibroids and a left ovarian tumor. Following a detailed examination and magnetic resonance imaging at our hospital, a TOA was suspected, and surgery was planned. During surgery, the adhesion was firm and required laparotomy. Ultimately, the left ovarian tumor was confirmed to be a TOA. Although complete surgical resection was not feasible. A surgical drain was inserted, and the pus was drained. Cultures revealed Citrobacter freundii and other organisms, and oral quinolone antibiotics were administered. CT performed on the fourth postoperative day demonstrated a residual abscess; however, 5 weeks after surgery, CT showed complete resolution of the residual abscess. Subsequently, the antibiotic regimen was terminated, and progestins were administered for the treatment of endometriosis, which is still ongoing.