Question

A 29-year-old G0 woman presents with a 10-month history of pelvic pain. Her pain is constant, rated as five out of 10 and is greater with intercourse especially on deep penetration. She was hospitalized for pelvic inflammatory disease and right tubo-ovarian abscess 14-months ago and was treated with parenteral antibiotics. She has a persistent right adnexal tubular mass on ultrasound. She desires future fertility. Her vital signs are normal. Pelvic examination reveals a retroverted, normal-sized uterus with limited mobility and marked tenderness and fullness in the right adnexa. Findings at the time of laparoscopy include multiple filmy and dense adhesions between the posterior uterus and cul-de-sac, normal left fallopian tube and ovary, and large right hydrosalpinx, with a few filmy adhesions between the normal appearing right ovary and distended fallopian tube. In addition to lysis of adhesions, what is the most appropriate procedure for this patient?

A. No further procedure is indicated
B. Needle aspiration of right hydrosalpinx
C. Right salpingostomy
D. Right salpingectomy
E. Right salpingo-oophorectomy

Answer 1

In the case of the 29-year-old patient with PID history and right hydrosalpinx, a right salpingectomy appears to be the most suitable procedure to preserve fertility while addressing the pain and risk of infection.

Step-by-step explanation:

The patient with a 10-month history of pelvic pain, previous hospitalization for pelvic inflammatory disease (PID) and a right tubo-ovarian abscess, and now presenting with a large right hydrosalpinx and adhesions at the time of laparoscopy is seeking treatment that preserves her future fertility. The most appropriate procedure, in addition to lysis of adhesions, would likely be right salpingectomy. This procedure involves the removal of the right fallopian tube, which is believed to be the source of her pain and complications, especially considering its distention and the previous abscess. A salpingectomy could potentially improve her pain and reduce the likelihood of further infections, while still preserving the right ovary and the left fallopian tube and ovary, which could still allow for future fertility. It is essential to balance the elimination of the diseased tissue with the preservation of reproductive potential, and in this case, a right salpingectomy seems most fitting.