Acute pelvic pain in reproductive-aged women presents a diagnostic challenge. In the case that follows, we report the management of a patient initially misdiagnosed with pelvic inflammatory disease.
A 14-year-old nulligravida who presented with acute pelvic pain was diagnosed with pelvic inflammatory disease and possible tuboovarian abscess. Despite treatment with broad-spectrum parenteral antibiotics, the patient remained febrile with persistent pelvic pain. Com-puted tomography revealed a duplicated right collecting system with the upper pole of the kidney drained by a markedly dilated, tortuous ureter. An infected ureterocele was identified and incised during cystoscopy.
An infected ureterocele was misdiagnosed as pelvic inflammatory disease. In patients with acute pelvic pain who do not respond to appropriate interventions, it is important to consider alternative diagnoses.
An infected ureterocele is initially misdiagnosed as pelvic inflammatory disease in an adolescent.
From the 1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and 2Department of Urology, Wayne State University School of Medicine, Detroit, Michigan.
Presented during the “Stump the Professors” session at the 2008 American College of Obstetricians and Gynecologists Annual Clinical Meeting, New Orleans, Louisiana, May 3–7, 2008.
Corresponding author: Valerie I. Shavell, MD, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, 3990 John R Street, 7 Brush North, Detroit, MI 48201; e-mail: email@example.com.
Financial Disclosure Dr. Diamond has been a consultant to Genzyme (Cambridge, MA), Omrix (New York, NY), Neomend (Woodstock, GA), MedElute (Kalamazoo MI), Johnson and Johnson (New Brunswick, NJ), Serono (Geneva, Switzerland), Kytogenics (Chatham, NJ), Takeda (Deerfield, IL), ARC Pharmaceutical (Dedham, MA), and Synthemed (Iselin, NJ). He holds a financial interest in Conceptus (Mountain View, CA), Synthemed, and Advanced Reproductive Care (Palo Alto, CA). He has received grant support from Johnson and Johnson, Boehringer Ingelheim (Ingelheim, Germany), Serono, Jackson Laboratory (Bar Harbor, ME), Meditrina Pharmaceuticals (Ann Arbor, MI), Neurocrine Biosciences (San Diego, CA), the National Institutes of Health (Bethesda, MD; from the Department of Veterans Affairs), and Wyeth (Madison, NJ). He also has served on the board of directors/advisory boards for Advanced Reproductive Care, ERGOT (Detroit, MI), American Society of Reproductive Medicine (Birmingham, AL), Society of Reproductive Endocrinology and Infertility (Birmingham, AL), and the CIG Group (Southfield, MI). The other authors did not report any potential conflicts of interest.