title: Ovarian endometrioma complicated by a Salmonella abscess caused by an enteroovarian fistula: a case report.
abstract: BACKGROUND
  Salmonella infection occurs primarily in the gastrointestinal tract but may also be found at extraintestinal locations. An ovarian abscess caused by Salmonella is one of the rare extraintestinal infections, and hematogenous spread by bacteremia to a preexisting ovarian cyst has been suggested as the cause of such infections.
  
  
  METHODS
  A 43-year-old woman presented with diarrhea, fever and an ovarian tumor and was treated initially with antibiotics for Salmonella bacteremia, followed by an exploratory laparotomy due to persistent fever and progressive toxic signs. A pus-containing endometrioma with a thick wall densely adhering to an intestinal segment, with a fistula connecting the 2, was found during surgery. The patient underwent a salpingo-oophorectomy and resection of the intestinal segment, took antibiotics and recovered. Bacterial culture of the abscess showed salmonellosis, and pathology reported a fistula between the ovarian tumor and intestine, suggesting that direct spread through a fistula may be one of the causes of extraintestinal Salmonella infections.
  
  
  CONCLUSIONS
  Salmonella infection located in the ovary is a rare condition, often caused by bacteremia. To the best of our knowledge, this is the first report of an ovarian Salmonella abscess that occurred through a fistula.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chao-Nin
authors.initials: CN
authors.lastname: Wang
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D000328:Adult; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000150:complications*; D006801:Humans; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D012475:Salmonella / Q000302:isolation & purification; D012480:Salmonella Infections / Q000175:diagnosis*; D016896:Treatment Outcome