Pyosalpinx in a Virgin Female Patient Misdiagnosed with Adnexal Torsion: A Case Report and Narrative Review

Pelvic inflammatory disease (PID) is an infection of the upper genital tract often caused by ascending sexually transmitted infection. However, this condition is very rare in preadolescent and adolescent virgin females who are not sexually active. Pyosalpinx is a complication of PID and a cause of acute abdominal pain misdiagnosed due to similar abdominal emergencies. A 14-year-old virgin female patient was admitted to the Emergency Department of a secondary care general Hospital in Birjand City, South Khorasan Province, Iran, in 2017. She presented with abdominal pain, nausea, vomiting, and fever started two days earlier. She had no history of vaginal discharge. Ultrasound findings indicated enlargement of the right ovary and a hypo-echogenic mass surrounded by a fluid; adnexal torsion suspected. Another cystic lesion with a thick wall and 14 mm diameter was detected in the left ovary. The patient underwent appendectomy four years earlier. Laparatomy performed due to acute abdomen and pyosalpinx was real diagnosis. The PubMed, Scopus, Clinical Key, and Up To Date were searched for articles published in the English language up to 2017, using various combinations of the following keywords (MeSH terms were not used): pyosalpinx, virgin, intact, entire, virtuous, Vestal, pure, and maiden. Although rare, it is important to keep the pelvic infection in mind in the differential diagnosis of virgin female patients presenting with clinical symptoms of an acute abdomen, especially in the ones with the history of gastrointestinal and urinary tract infection or surgery.