Vegetable fibre in an infected ovarian dermoid cyst

Tubo-ovarian abscesses (TOAs) are inflammatory masses involving the fallopian tube, ovary and occasionally other adjacent pelvic organs. A 32-year-old woman with no significant medical history presented with a chief complaint of lower abdominal pain. Initial CT of the abdomen was suggestive of a colon abscess; however, a repeat CT suggested a TOA. The left ovary was densely adherent to the left pelvic sidewall and the rectosigmoid colon. The content of the ovary was consistent with a dermoid and suspected of superinfection. Pathological examination of the tissue revealed normal ovarian cortical tissue, hair cells, melanin, and epidermal and neural tissue, as well as evidence of a foreign object resembling vegetable matter. The vegetable fibre found in this patient's biopsy was of an unclear aetiology, but probably indicates a perforation of the bowel. Any cause of bowel perforation adjacent to the adnexa can lead to TOA, therefore providing a rational speculation for this case.