Bilateral Pyosalpinx Mimicking Acute Appendicitis: An Uncommon but Critical Diagnostic Challenge

A perforated appendix has been believed to be a potential risk for damage to adnexal structures that may escalate the chances of infertility in girls in future. Acute complications that are uncommomly described postperforation of appendix may be salpingitis, hydrosalpinx, and pyosalpinx. A pyosalpinx or tubal abscess is the acute inflammation of the fallopian tube that fills up and swells with pus, which commonly results from inadequate or delayed treatment of pelvic inflammatory disease (PID). Pyosalpinx may present with common symptoms such as lower abdominal pain, vomiting, nausea, per vaginal discharge, and lesser noted symptoms such as fever and chills or remain silent. Primay pyosalpinx might occur as a severe sequelae of PID that is characterized by the inflammation of upper genital tract incorporating endometritis, salpingitis, and pelvic peritonitis. Secondary pyosalpinx, on the other hand, arises from adjacent pelvic structures such as appendix, colon, urinary bladder or may be from a pelvic malignancy. Herein, we report the case of acute appendicitis with bilateral pyosalpinx.