Hydronephrosis and loin pain as a presentation of tubo-ovarian abscess developing after Mirena coil removal

Abstract

We present an unusual and complicated case of a 39-year-old woman who was admitted three times in hospital over a period of 4 weeks, with abdominal pain initially and then right loin pain, fever and feeling generally unwell. She was investigated on each admission with different diagnoses set each time, but only on her last admission due to persisting symptoms, an MRI scan revealed a tubo-ovarian abscess associated with pelvic inflammatory disease (PID). We believe that the PID had developed secondary to the intrauterine device and a few weeks after the removal of the Mirena coil she was diagnosed with a tubo-ovarian abscess. As the case unfolds, we will introduce the possible diagnoses and causes that were likely to have led to the development of the abscess. Copyright 2012 BMJ Publishing Group. All rights reserved.