Bilateral pyosalpinx in a peripubescent female with Hirschsprung's disease: a case report

This is a case report of bilateral pyosalpinx in a peripubescent female with a history of Hirschsprung's disease. Bilateral pyosalpinx is a rare condition in non-sexually active females. The presence of this disease in a patient with a history of Hirschsprung's disease is concerning for an association of the two processes.A 12 year old female presents to the emergency department with a complaint of abdominal pain. She has a past medical history of Hirschsprung's disease with a staged repair. At day four of life she underwent colostomy with resection of the affected colon from the mid transverse colon to the junction of the sigmoid and descending colon. She returned two months later for the second stage of the repair where she underwent a Soave endorectal pull thru procedure with incidental appendectomy. Since that time she has had a good recovery without constipation or diarrhea and with normal bowel function. She had recurrent tonsillitis and underwent tonsillectomy. She takes no medications. The patient complains of a sharp bilateral lower abdominal pain for the past two days that is greatest in the suprapubic region. She has had three episodes of emesis. She denies a change in bowel habits. She does report a low grade fever to 101. She denies dysuria, frequency or hematuria. She denies any history of sexual activity. Her first menstrual period was six weeks ago and her second menstrual period was two weeks ago. She complains of a new watery vaginal discharge for less than one day.Upon arrival her vitals are temperature 37.2 degrees Celsius by mouth, pulse 125 beats per minute, blood pressure 124/64 mm/Hg, and pulse ox 96% on room air. She weighs 45 kg. She is in obvious moderate distress due to her pain. Her bowel sounds are normal. Her abdomen is non distended and firm with voluntary guarding. It is diffusely tender, but worse in the bilateral lower quadrants without rebound tenderness. There is no CVA tenderness. On pelvic exam, there are normal external genita