UNCOMMON PRESENTATION OF RECURRENT INFLAMMATORY PELVIC DISEASE: MUCOCYSTIC DEGENERATION OF THE FALLOPIAN TUBE
Pelvic inflammatory disease (PID) is an acute and sometimes subclinical infection of the upper genital tract in women, involving any of the uterus, fallopian tubes and ovaries. The condition commonly can involve also the other pelvic organs mainly the peritoneum. It results in oophoritis, salpingitis, tubo-ovarian abscess, peritonitis or perihepatitis. A 26-year-old woman was admitted in our clinic for lower abdominal pain, fever and vaginal discharge. The ultrasound aspect was suggestive for PID with tubal involvement (salpingitis). The lab finding proved an important inflammatory syndrome (high C protein level, elevated white blood cells count). We decided to perform exploratory laparoscopy for PID. Intraoperative findings consisted of: both fallopian tubes were enlarged, with congestive vascularization and adhesion process to the surrounding tissue resulting in bilateral tubo-ovarian abscess. Due to further patient wish to conceive we decided to perform conservative treatment: lavage and drainage of the abscess. The patient outcome was favorable with the discharge in the 3rd postoperative day. The patient returns in our unit after 6 months following the operation for similar symptomatology. The clinical and ultrasound examination established the diagnosis of recurrent PID bilateral sactosalpinx. We decided to perform laparoscopic surgery, with bilateral salpingectomy. The patient had no gynecological complain one year later. The histopathological examination depicted an unusual degeneration of the fallopian tube of mucocystic aspect. We presented a case with clinical and imaging scan that imposed the diagnosis of Pelvic Inflammatory Disease. The particularity of this case is the pathological exam that proved the mucocystic degeneration of the fallopian tube. It represents an extremely rare condition.