Abstract:

Pelvic abscess in adolescent females without a history of sexual activity is clinically rare. It is often caused by occult etiologies, presents with non-specific clinical manifestations, and carries a high rate of misdiagnosis and missed diagnosis, which can easily lead to delays in treatment. We report a case of an 11-year-old adolescent female. The patient initially presented with persistent fever. After receiving anti-infective therapy in department of pediatric internal medicine, her symptoms showed no improvement, and the condition progressed, leading to low-grade fever and dull lower abdominal pain. Imaging studies revealed a large, mixed echogenicity pelvic mass of undetermined nature. The patient underwent emergency laparoscopic exploration. Intraoperatively, extensive pelvic adhesions, a left tubo-ovarian abscess, and bilateral pyosalpinx were observed. Simultaneously, a retained plastic bottle cap was removed from the vagina. Postoperatively, the patient received standardized anti-infective and supportive therapy. The clinical symptoms resolved completely, and the prognosis was favorable. Retention of a genital tract foreign body is an occult high-risk factor for pelvic abscess in adolescents. Due to the absence of a sexual history and a concealed history of foreign body contact, clinical recognition is challenging. For adolescent girls with fever of unknown origin who are unresponsive to anti-infective therapy, routine screening for vaginal foreign bodies and pelvic suppurative lesions is necessary. Early completion of imaging studies and timely surgical intervention should be implemented to avoid long-term complications such as pelvic adhesions, thereby protecting the reproductive health and fertility of adolescent females.

Key words: Adolescent, Pelvic inflammatory disease, Abscess, Vagina, Foreign bodies, Fertility preservation