Hospital: H U A
Aut@r o Autores: D. Quintana Blanco, E. Santos Corraliza, A. Gamarra, J. Sagasta Urrutia, L. Alonso Irigaray, E. Díez Lasheras.
We present a 13 year-old girl with 2 weeks of abdominal pain and in the right iliac quadrant for the last 24 hours, 3 days prior to expected menstruation day. The patient denied depositional rhythm alteration. Blood routine showed elevation of RCP (55,3) and leukocytosis (15.700) with neutrophylia (82,3%). Appendicitis was suspected. Abdominal US showed a 6 mm appendix, thickened distal ileum and a heterogeneous ovarian cyst. During follow-up imaging, the ovarian cyst showed growth and a patent air bubble, with surrounding ileitis. The patient underwent surgery on the suspicion of tubo-ovarian abscess, with surgical finding of ileum loops adhered to right ovarium (right adnexectomy was performed) After further follow-up and imaging with worsening of symptoms, Crohn’s disease with fistulization to ovarium was diagnosed
Tubo-ovarian abscess is a rare complication of Crohn’s disease. Subtle ultrasound findings like air in a cyst must not be overlooked, and differential diagnosis of tubo-ovarian abscesses with ilium inflammation must be taken into account.
This case shows how multiorganic involvement and specific findings like bubbles of air can cut-up differential diagnosis.
- Brito Panizza PS et al. Inflammatory Bowel Disease: Current Role of Imaging in Diagnosis and Detection of Complications RadioGraphics 2017, 37:701–702