A case report: Concurrent bilateral tubo-ovarian abscess and acute appendicitis

Tubo-ovarian abscess (TOA) and acute appendicitis are 2 entities with similar clinical presentation that they often mimic each other. Concurrence of both of these pathologies is rare and diagnostically challenging due to the overlapping clinical features. We report a case of a 40-year-old female with several emergency visits, presenting with atypical presentation of intermittent bilateral flank pain, subjective fever and vomiting. Contrast-enhanced computed tomography (CT) scan confirmed bilateral TOA, with the appendix initially presumed to exhibit reactionary inflammation. Subsequent surgical intervention and histological findings later confirmed acute suppurative appendicitis in the presence of bilateral TOA, after which the patient showed clinical improvement. This emphasizes the importance of radiological imaging modalities in detecting coexisting abdominal-pelvic diagnoses, which may otherwise be overlooked. Highlighting the importance of considering dual pathology and having high clinical suspicion, as early identification of these diagnoses is critical for appropriate treatment planning and improved outcomes.