CASE HISTORY

Para 2, normal deliveries. History of irregular vaginal bleeding for seven months and constant bleeding and discharge for six weeks. Blood was partially clotted and discharge greenish and offensive. Frequency and burning for two weeks on urination accompanied by a constant ache in the left lower abdomen. On examination there was marked tenderness in the LLQ of the abdomen and an underlying mass could be felt. Vaginal examination revealed a cystocele, rectocele and bleeding from the uterus with tenderness in the left fornix. Slight temperature. WBC 13,000. A bilateral salpingo- oophorectomy and subtotal hysterectomy was performed. Convalescence satisfactory.

PATHOLOGY

The specimen consists of uterus, tubes and ovaries removed at operation. The left tube is thickened, injected and contains a purulent material. The end is expanded into a well defined, thick-walled abscess which contained yellow pus. This abscess seems to be involving the end of the tube alone, giving it a retort-shaped appearance, and not the ovary which can be seen outside the wall, but adherent to it. The right tube and ovary are swollen, deeply injected and covered with a fibrino-purulent exudate. No abscess is present on this side. The thickening and abscess formation are the result of a chronic inflammation.