Group A streptococcal peritonitis and ruptured tubo-ovarian abscess three years after Essure® insertion: a case report

Ido Solt, Yevgeniya Ioffe, Raymond Geoffrey Elmore, M. Jonathon Solnik
Journal of women's health (2002) · 2011 · vol. 20(5) , pp. 781–783 · doi:10.1089/jwh.2010.2574 · PMID:21599428 · W2007942681
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This case report details a ruptured tubo-ovarian abscess and peritonitis in a 24-year-old woman three years after Essure insertion, suggesting tubal occlusion may not prevent ascending pelvic infections.

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Abstract

We describe a complicated ruptured Streptococcus pyogenes tubo-ovarian abscess (TOA) and peritonitis in a 24-year-old woman, necessitating eventual hysterectomy and a prolonged intensive care unit (ICU) admission 3 years after successful tubal occlusion with Essure® (Conceptus, Inc., Mountain View, CA) microinsert devices. The patient is a 24-year-old gravida 3, para 2, aborta 1 (G3P2Ab1) who had a 1-day history of worsening right lower quadrant pain without associated fever or cervical motion tenderness. Patient's medical history was complicated by mitochondrial neurogastrointestinal encephalopathy (MNGIE). Upon her admission to the hospital, an exploratory laparoscopy was performed. Intraoperative findings revealed a ruptured right-sided TOA. S. pyogenes was isolated from the peritoneal fluid and cervicovaginal cultures. After the laparoscopy, the patient experienced initial improvement but abruptly worsened and on postoperative day 7 was returned to the operating room for a planned repeat exploration and total abdominal hysterectomy. Gross pathological examination of the uterus showed appropriate Essure insert placement. Based on this case, tubal occlusion by induced fibrosis may not be a sufficient obstacle in preventing ascending pelvic infections.

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MeSH descriptors

Abscess Pelvic Inflammatory Disease Peritonitis Sterilization, Tubal Streptococcal Infections Streptococcus pyogenes Streptococcus pyogenes Abscess Abscess Female Humans Hysterectomy Intestinal Pseudo-Obstruction Intestinal Pseudo-Obstruction Mitochondrial Diseases Mitochondrial Encephalomyopathies Mitochondrial Encephalomyopathies Muscular Dystrophy, Oculopharyngeal Ophthalmoplegia Ophthalmoplegia

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