title: Persistent ischiorectal fistula with supralevator origin secondary to a chronic tubo-ovarian abscess:  report of a case and review of the literature.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Erol V
authors.initials: EV
authors.lastname: Belli
authors.forename: Ron G
authors.initials: RG
authors.lastname: Landmann
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Koonce
authors.forename: Anita H
authors.initials: AH
authors.lastname: Chen
authors.forename: Philip P
authors.initials: PP
authors.lastname: Metzger
mesh_terms: D018784:Abdominal Abscess / Q000150:complications*; D000368:Aged; D017577:Cutaneous Fistula / Q000209:etiology* / Q000601:surgery; D005184:Fallopian Tube Diseases / Q000150:complications*; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010049:Ovarian Diseases / Q000150:complications*; D010052:Ovariectomy; D058994:Salpingectomy