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J Pediatr Adolesc Gynecol. 2013 Aug;26(4):e99-102. doi: 10.1016/j.jpag.2013.02.004. Epub 2013 Apr 6.

Tubo-ovarian abscess in virginal adolescent females: a case report and review of the literature.

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Division of Pediatric Gynecology, Children's Hospital of Eastern Ontario, Faculty of Medicine, University of Ottawa, Canada.



A tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), predominantly polymicrobial and present in sexually active women. TOA in virginal adolescent females are extremely rare but have serious and lifelong consequences.


A 13 y.o. virginal female presented to the Emergency Room of a tertiary care pediatric hospital with abdominal pain and vomiting. Imaging suggested bowel compromise with potential perforation. An exploratory laparotomy revealed TOA which grew Escherichia Coli. This is the first reported case of Escherichia Coli TOA due to suspected bowel translocation.


Review of the literature identified 8 cases of TOA in virginal adolescents. Given the severity of outcomes following TOA, this pathology should be considered in the differential diagnosis of virginal adolescents who present with fever and abdominal pain. If suspected, a prompt gynecology consult should be initiated, followed by a first line antibiotic therapy and when indicated, surgical drainage.


Adolescents; Bowel translocation; Escherichia Coli; Pelvic inflammatory disease; Tubo-ovarian abscess; Virginal

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