Tubo-ovarian Abscess in Virginal Adolescents: Exposure of the Underlying Etiology

Tubo-ovarian abscesses (TOA) are acute complications of pelvic inflammatory disease (PID). PID is an infection of the upper genital tract that is usually caused by an ascending sexually transmitted infection. We present two cases of TOA in patients who deny any history of sexual activity or sexual abuse. In our first case a TOA was the primary manifestation of Crohn's disease. The TOA in our second case was attributed to a combination of obesity, constipation, recurrent urinary tract infections, and poor hygiene. In both cases the laparoscopic evaluation revealed purulent fluid collections in the fallopian tubes that were not evident on imaging. These cases support the use of laparoscopy for diagnosis in atypical cases.