Unusual presentation of tubo-ovarian abscess in a non-sexually active adolescent girl

A tubo-ovarian abscess (TOA) is a rare presentation in non-sexually active adolescent. The majority of the public health impact from pelvic inflammatory disease (PID)comes from its attributable long-term sequelae, including tubal-factor, infertility, ectopic pregnancy, and chronic pelvic pain. A 15-year-old girl presented with complaints of severe right sided lower abdominal pain for one day. She had dull-aching lower abdominal pain for 2 months. She had undergone appendicular abscess drainage with appendectomy three years ago. On examination she had tenderness over suprapubic and right iliac fossa region, no mass palpable. Blood investigations done showed leucocytosis with neutrophilic shift. Ultrasound abdomen done showed dilated tube measuring 5.6×1.7 cm with thick walls and internal echoes in the right adnexa. CECT abdomen done showed large, heterogenous loculated collection with thick enhancing walls seen in the retro-vaginal pouch of Douglas, features suggestive of tubo-ovarian abscess. She underwent Abscess drainage with Right tubo-ovarian abscess cavity resection with omental and bowel adhesiolysis. Histopathology was reported as Tubo ovarian abscess with no evidence of granulomatous inflammation. Pus and tissue sent for XPERT PCR showed no AFB present. She recovered well postoperatively and was discharged in healthy condition. Although PID is rare in non-sexually active girl but need to considered as a differential diagnosis.