Diverticulitis Mimicking a Tubo-ovarian Abscess: An Atypical Presentation with Definitive Diagnosis and Treatment by Laparoscopy

　　　　　背景:長時期陰道異物留置在診斷上有其盲點，尤其當陰道異物被讖維化的結疤 組織覆蓋時。 病例報告:一位十九歲女性被大量的惡臭陰道分泌物困擾超過三年之久。在本院接受抗 生素治療幾日無效，臨床上懷疑可能有一被覆蓋的陰道異物。經手術，取出一長方體的塑膠 物，証實為電動按摩棒之振動部。 結論:仔細尋問病史及高度的警覺心是診斷陰道異物最重要的一環。其他完整的診斷方 法包括理學儉查、陰道超音波、腹部X光、電腦斷層、核磁共振及陰道顯影。手術取出時， 須小心謹慎以避免其他器官的傷害。
　　　　　Background: Diverticulitis presenting as localized tubo-ovarian abscess is reported in the literature sporadically, and the use of laparoscopy to manage such a condition is rare. Case report: A 32-year-old woman was referred to our hospital because of persistent fever and left lower quadrant pain despite use of parenteral antibiotics. Left tubo-ovarian abscess was diagnosed, and surgical intervention with laparoscopy for drainage was performed. In operation, the sigmoid colon adjacent to the tube was revealed to have a redundant, thickened, phlegmon, indurated lesion and a small abscess cavity involving the pericolonic sigmoid mesocolon and left fallopian tube. We separated the left tube from the sigmoid colon and removed the left tubal abscess; two penrose rubber drains were inserted for irrigation and drainage. The patient was discharged on postoperative day 8. She had no complications in the follow-up course. Conclusions: Presenting signs and symptoms of acute diverticulitis are nonspecific and similar to many causes of peritoneal irritation. The current laparoscopic technique facilitates direct visualization of abdominal contents and can provide precise diagnosis.