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Persistent Ischiorectal Fistula With Supralevator Origin Secondary to a Chronic Tubo-Ovarian Abscess: Report of a Case and Review of the Literature

Belli, Erol V. MD; Landmann, Ron G. MD; Koonce, Stephanie L. MD; Chen, Anita H. MD; Metzger, Philip P. MD

Female Pelvic Medicine & Reconstructive Surgery: January/February 2012 - Volume 18 - Issue 1 - p 66–67
doi: 10.1097/SPV.0b013e31823bdbe2
Case Reports

Background Chronic tubo-ovarian abscess is an uncommon finding in postmenopausal women. This abscess may rupture or fistulize to adjacent organs into the ischiorectal space.

Case A gravida three, para three, postmenopausal woman with extensive sigmoid diverticulosis presented with perianal fistula of 2 years’ duration. Magnetic resonance imaging showed the tract to have a supralevator origin adjacent to the sigmoid colon. She had no recent instrumentation other than preoperative colonoscopy. Intraoperatively, the fistula tract origin was noted to be from a right tubo-ovarian abscess. She was treated with right salpingo-oophorectomy and tract excision/sealing. At 4-month follow-up, the fistula tract was healed with no further drainage.

Conclusions Tubo-ovarian abscess should be considered in the differential diagnosis of supralevator fistula in postmenopausal women when no other source can be localized.

Seventy-year-old woman presenting with a persistent ischiorectal fistula found to be secondary to a chronic tubo-ovarian abscess and fistula.

From the Division of Colorectal Surgery, Mayo Clinic, Jacksonville, FL. Reprints: Philip P. Metzger, MD, Division of Colorectal Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224. E-mail:

The authors declare that they have nothing to disclose.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins