Complicated clinical course of acute pelvic inflammatory disease


  • Anna Kornete Department of Obstetrics and Gynecology, Riga East Clinical University Hospital, Riga, Latvia
  • Zane Paunina Department of Obstetrics and Gynecology, Riga East Clinical University Hospital, Riga, Latvia
  • Zane Grabe Department of Obstetrics and Gynecology, Riga East Clinical University Hospital, Riga, Latvia



Pelvic inflammatory disease, Sepsis, Multi-drug resistance


The absence of both the classic risk factors for pelvic inflammatory disease (PID) and the triad of cervical motion, uterine or adnexal tenderness does not preclude the diagnosis of PID and tubo-ovarian abscess. The clinical case demonstration presents the perimenopausal woman with complicated clinical course of acute PID.


Chappell CA. Pathogenesis, Diagnosis, and Management of Severe Pelvic Inflammatory Disease and Tuboovarian Abscess. Clin Obstet Gynecol. 2012;55:893-903.

Lareau SM, et al. Pelvic Inflammatory Disease and Tubo-ovarian Abscess. Infect Dis Clin N Am. 2008;22:693-708.

Jackson SL. Pelvic Inflammatory Disease in the Postmenopausal Woman. Ind Dis Obstet Gynecol. 1999;7:248-52.

Shepherd SM. Pelvic Inflammatory Disease. Available from-

Hui CK. Recurrent extended-spectrum beta-lactamase-producing Escherichia coli urinary tract infection due to an infected intrauterine device. Singapore Med J. 2014;55(2):28-30.

Hoffman M. Tuboovarian abscess in postmenopausal women. J Reprod Med. 1990;35:525-8.

Halperin R. Predictors of tuboovarian abscess in acute pelvic inflammatory disease. J Reprod Med. 2008;40-53.

Joyeux E. Before surgery predictability of malignant ovarian tumors based on ADNEX model and its use in clinical practice. Gynecol Obstet Fertil. 2016;44(10):557-64.

Ognong-Boulemo A, Dohan A, Hoeffel C, Stanek A, Golfier F, Glehen O, Valette PJ, Rousset P. Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI. Abdominal Radiol. 2017:1-8.

Foti PV. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging. 2016:7(1):21-41.

Kouijzer IJE. Initially unrecognised group A streptococcal pelvic inflammatory disease in a postmenopausal woman. Neth J Med. 2014;72:494-6.

Mascolino A. Large retroperitoneal abscess extended to the inferior right limb secondary to a perforated ileal Crohn's disease: the importance of the multidisciplinary approach. G Chir. 2016:37:37-41.

Zheng J. Gangrenous appendicitis caused huge retroperitoneal abscess and scrotal abscess: a case report and literature review. Int J Clin Exp Med. 2016;9(10):20383-6.

Ng NY, Twoon M, Thomson SE. Psoas abscess and severe fasciitis due to a caecal carcinoma. BMJ case reports. 2015;2015:bcr2014207494.

Spiliopoulos D. Psoas Abscess after Radical Abdominal Hysterectomy: A Case Report and Review of the Literature. The Open Clin Cancer J. 2010;4:15-9.

Christensen L. Necrotizing Fasciltis Case Presentation and Literature Review. N Y State Dent J. 2015;81(4):24-8.

Gujral S. Necrotizing Fasciitis. 2014 Available at

Hakkarainen TW. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344-62.

Amaranathan A. Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess-Rare and Perilous. Cureus. 2017;9(1):982.

Singer M. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016;315(8):801-10.

National Institute for Health and Care Excellence. Sepsis: recognition, assessment and early management; 2016.

Lepper PM. Clinical implications of antibiotic-induced endotoxin release in septic shock // Intensive Care Medicine. 2002;28:824-33.

Holzheimer RG. Antibiotic Induced Endotoxin Release and Clinical Sepsis: a Review. J Antimicrob Chemother. 2013;3:159-72.

Otto M. Staphylococcus epidermidis: the accidental pathogen. Nat Rev Microbiol. 2009;7(8):555-67.

Almasaudi SB. Acinetobacter spp. as nosocomial pathogens: Epidemiology and resistance features. Saudi J Biologic Sci; 2016.






Case Reports