输卵管–卵巢脓肿误诊为卵巢恶性肿瘤一例

A Case of Tubo-Ovarian Abscess Disguising as Ovarian Malignancy

病史摘要:患者,女,48岁,因“下腹痛2周,扪及盆腔包块1周”就诊于我院。患者2周前经期出现下腹隐痛,伴腹泻,无发热,无腹胀,无异常阴道流液等不适。腹泻症状持续3天后自行好转。1周前患者扪及下腹部包块,质硬,平脐,伴肛门坠胀感。影像学检查提示:卵巢恶性肿瘤可能性大。排除手术禁忌后行手术治疗,术中诊断为:输卵管–卵巢脓肿。术后予以抗生素抗感染治疗。专科检查:阴道内见少许白色分泌物,无腥臭味;宫颈光滑,质韧,盆腔扪及实性包块,大小约20*20 cm,双侧达盆壁,上极平脐,下极达子宫直肠陷凹,活动性差,压痛明显,未扪及双侧附件区。直肠指诊:进指3 cm处可触及质硬包块,活动度差,界限不清,凸向直肠,退指指套无血染。诊断方法:妇科超声、盆腔核磁共振等影像学检查,肿瘤标志物,术中所见及术后病理。治疗方法:排除禁忌后行手术治疗,术后予以对症治疗。临床转归:患者术后恢复可,无发热,无阴道流血等不适。适合阅读人群:妇科,普外科,影像科。

Summary of case history: A 48-year-old woman was admitted to our hospital due to “Lower ab-dominal pain for 2 weeks, palpable pelvic mass for 1 week”. 2 weeks ago, she presented with pro-gressively aggravated abdominal pain and diarrhea without fever during menstruation. Diarrhea Symptoms disappeared after 3 days. One week ago, the patient had palpable mass in the lower ab-domen, hard and flat umbilicus, accompanied by a sense of anal distension. The pelvic ultraso-nograms illustrated complex pelvic masses highly suspicious for neoplasm. Surgical exploration revealed tubo-ovarian abscess. Antibiotic anti-infection treatment was given after operation. Symptoms and signs: There was a little white secretion in vagina, no peculiar smell. The cervix was smooth and tough. Solid and hardly removable mass was palpable in the pelvic cavity with a size of about 20*20 cm, bilateral reaching pelvic walls, the upper flat to the umbilical cord, the lower reaching uterine rectum depression, while bilateral adnexal areas were untouched. Digital rectal examination: hard mass can be touched at 3 cm into the finger, immovable and unclear boundary, convex to the rectum. No blood stained on the back finger sleeve. Diagnostic methods: Based on auxiliary examination results such as gynecological ultrasound, pelvic magnetic resonance imaging and tumor markers, the diagnosis was confirmed by intraoperative findings and postoperative pa-thology. Therapeutic methods: After eliminating contraindications, surgical treatment was per-formed. And symptomatic treatment was given after surgery. Clinical outcomes: The patient has recovered after treatment without fever, vaginal bleeding and other discomfort. It’s suitable for reading: department of gynecology, general surgery and imaging.