2 Case Reports in Medicine Tuboovarian abscess and air-ﬂuid levels Tuboovarian abscess Sigmoid colon (a) Sigmoid colon (b) Percutaneous drainage (c) Figure 1: (a) The sigmoid colon was lying between two tuboovarian masses, and its borders could not be distinguished from the ovaries. (b) The sigmoid colon was lying between two tuboovarian masses. (c) Percutaneous drainage. constipation. Her past medical history was unremarkable except for morbid obesity. The patient was 160 kg with a BMI of 35.5. Physical examination demonstrated fever (39◦C) and mild tachycardia (110/minute) with bilateral lower abdom- inal quadrant tenderness. Her blood analysis revealed an elevated white blood count (20.600/mm3) and anemia (8.5 g/dL). Her erythrocyte sedimentation rate was 90 mm/h. Pelvic ultrasonography showed bilateral cystic pelvic mass, but the result was considered to be unsatisfactory due to morbid obesity. CA 125 level was 233 IU/mL. Her blood and urine cultures were found to be negative. Her abdominopelvic computed tomography scan revealed bilateral complex adnexal masses. The left and right lesions were measured to be 19 × 11 cm and 8.5 × 10 cm in size, respectively. Both of the lesions were multiseptated with prominent air-ﬂuid levels suggesting tubo-ovarian abscesses (Figures 1(a), 1(b), and 1(c)). The sigmoid colon was lying between two tuboovarian masses, and its borders could not be distinguished from the ovaries. The mesentery of the sigmoid colon was also found to be thickened due to inﬂammation. The uterus was found to be normal without any sign of pelvic inﬂammatory disease. The patient was presumed to have bilateral tuboovarian abscesses which developed as a complication of the sigmoid diverticulitis. Intravenous ﬂuid replacement was started, and oral intake was avoided. Since the patient had fever, tachycardia, and elevated white blood count, she was administered piperacillin-tazobactam by the department of infection diseases considering the risk of sepsis with a dose of 4.5 g four times a day intravenously. Percutaneous drainage under ultrasonographic guidance was performed using two drainage catheters. A total of 1000 mL purulent material was aspirated from both lesions. The catheters were left in place for further drainage. Three diﬀerent bacteria including Escherichia coli, Veillonella, and Peptostreptococcus grew on the cultures of the abscess drainage ﬂuid. During the followup, the clinical condition of the patient gradually improved. She became afebrile, and her white blood count returned to normal level. She was allowed oral intake on the 7th day of hospitalization. Serial ultrasonograms were performed, and decrease in abscess sizes was noted. On the 19th day of hospitalization, the drainage catheters were removed. The patient was discharged on 22nd day of hospitalization with prominent clinical and radiological improvement. 3. Discussion Since tuboovarian abscess is almost always a complication of pelvic inﬂammatory disease, it is rarely observed in virgins. However, a review of the literature revealed that