Pyosalpinx-Induced Pelvic Sepsis Prompting Bilateral Salpingo-Oophorectomy and Laparoscopic Hysterectomy in a Premenopausal Woman

Pyosalpinx is a rare infection of the fallopian tube characterized by pus accumulation and inflammation, which can progress to severe sepsis if not promptly treated. We describe a 54-year-old premenopausal woman who presented with fever, localized abdominal pain, and laboratory findings consistent with sepsis. Diagnostic imaging revealed a complex adnexal mass concerning for a tubo-ovarian abscess. Despite empiric broad-spectrum antibiotic therapy, the infection persisted, prompting a robotic-assisted total laparoscopic hysterectomy with bilateral salpingo-oophorectomy for definitive source control. Surgical pathology confirmed pyosalpinx with abscess formation. The presence of clue cells and the absence of sexually transmitted pathogens suggested bacterial vaginosis as the likely infectious source. This case emphasizes that upper genital tract infections can occur in women without traditional risk factors and that altered vaginal flora may play a significant role in their development. Prompt diagnosis, empiric antibiotic coverage, and timely surgical intervention remain crucial to prevent complications and ensure favorable outcomes.