Rupture of tubo-ovarian abscess in second trimester of pregnancy: A case report at Dr. Soetomo Hospital Surabaya

The aim of this study is to report a case of a tubo-ovarian abscess (TOA) in pregnancy. TOA is a complex infectious mass of the adnexa that develops as a consequence of pelvic inflammatory disease, mostly found in reproductive age women. However, incidences in pregnant woman are considering extremely rare. The recent study regarding TOA in pregnancy was conducted in 2021 with only 40 cases reported. It risks a maternal morbidity, mortality, and fetal jeopardy. To conduct this study, the case was a 28 years-old woman, 24/25 weeks primigravidae presenting at Dr. Soetomo Hospital emergency room with chief complaints abdominal pain, fever, and abdominal tenderness. Laboratory examination revealed leukocytosis, elevated CRP, and Procalcitonin. Abdominal MRI showed a right adnexal mass measuring ± 7.2 x 5.1 x 2.9 cm. Emergency laparotomy was performed due to the presence of peritonitis, a ruptured TOA and appendix inflammation were found. Abscess drainage followed by cyst wall excision, irrigation, and appendectomy were done. Microbiological culture was performed on abdominal pus samples taken during surgery. A histopathological and microbiological examination confirmed the diagnosis of TOA. The TOA occurrence in pregnancy is hardly recorded due to its low prevalence. Diagnosing during pregnancy can be difficult due to the similarity of symptoms and laboratory findings with other illnesses. Although rare, TOA in pregnancy can cause a poor prognosis for both the pregnant mother and the fetus. Diagnosis is also not easy because of its rarity. Making a prompt diagnosis can help to improve the outcomes.