Tubo-ovarian abscess in an adolescent with uterine didelphys and prior cloacal repair: case report and literature review.

Tubo-ovarian abscess (TOA) is an uncommon complication of pelvic infection, particularly in patients with Müllerian anomalies. We report the case of a 16-year-old girl with uterine didelphys and a history of cloacal repair who presented with fever, abdominal pain, and a large multiloculated left adnexal mass. Laparoscopy revealed a TOA within a severely distorted pelvis, requiring extensive adhesiolysis, excision of the abscess cavity with adherent tubal remnants, and partial cystectomy with ovarian preservation. Histopathology confirmed a purely inflammatory process, excluding malignancy. This case highlights a non-obstructive mechanism for TOA, in which distorted pelvic anatomy and postsurgical adhesions predisposed to infection, underscoring the need for individualised evaluation and fertility-preserving management in this population.