Salmonella-induced adnexal abscess superimposed on ovarian endometrioma and adenomyosis

Salmonella-induced tubo-ovarian abscesses (TOAs) in patients with ovarian endometriomas and coexisting adenomyosis are rare and surgically challenging due to dense adhesions. We report a woman in her late 30s presenting with 2 weeks of worsening left iliac fossa pain. She exhibited cervical motion tenderness and significantly elevated inflammatory markers, including a white blood cell (WBC) count of 22.7×10⁹/L and CRP of 185.9 mg/L. Ultrasound revealed a 7.1 cm complex left adnexal cyst. After 72 hours of intravenous antibiotics (ceftriaxone, metronidazole) and oral doxycycline, she successfully underwent a laparoscopic left adnexectomy, subtotal hysterectomy with right salpingectomy, at her request. She recovered fully within 2 weeks. This case demonstrates that laparoscopy is the preferred management for complicated TOA with endometrioma and adenomyosis, and that 72 hours postantibiotic initiation is the optimal timing for surgery.