Subacute Bilateral Adnexitis in a Woman with Prior Tubal Sterilization: A Case Report.

Abstract

Background:
Adnexitis — inflammation of the uterine adnexa — commonly occurs as a component of pelvic inflammatory disease (PID). Although tubal sterilization may reduce the likelihood of ascending upper genital tract infection, PID can still occur after sterilization. This case illustrates subacute bilateral adnexitis arising 12 years after tubal sterilization.

Case Report:

A 46-year-old multiparous woman with prior bilateral tubal ligation presented with one week of progressive lower abdominal pain, low-grade fever (38.1 °C), foul-smelling vaginal discharge, and dyspareunia. Examination revealed suprapubic tenderness and bilateral adnexal tenderness without palpable adnexal masses. Investigations showed leukocytosis (16.8 × 10³/μL) and pyuria on urinalysis (15–20 WBCs/HPF, leukocyte esterase 2+) with negative nitrite. Urine pregnancy test was negative. Pelvic ultrasonography showed bilateral thickened, mildly dilated fluid-containing fallopian tubes with increased vascularity and mild free fluid in the pouch of Douglas, without tubo-ovarian abscess or adnexal mass, supporting bilateral adnexitis. A clinical diagnosis of subacute bilateral adnexitis was made. The patient received intravenous ceftriaxone 1 g twice daily plus analgesic and supportive care. By the third day of treatment, abdominal pain had decreased markedly, temperature had normalised to 36.5 °C, and bilateral adnexal tenderness had resolved.

Conclusion:
Subacute bilateral adnexitis can develop in previously sterilized women. The diagnosis may be supported by a combination of persistent pelvic pain, adnexal tenderness, fever, leukocytosis, and compatible pelvic ultrasonographic findings, allowing empirical treatment to be initiated. Microbiological sampling should be obtained where feasible, and antibiotic therapy should provide appropriate coverage for gonococcal, chlamydial, and anaerobic organisms.