Salpingitis in an Adolescent Female With Constipation and Abdominal Pain

**Background:** Abdominal pain is a common pediatric emergency presentation, with constipation accounting for 20% of cases. Gynecologic conditions such as pelvic inflammatory disease (PID), ectopic pregnancy, ovarian torsion, and cyst rupture must also be considered. This case report describes a novel presentation of radiographic salpingitis secondary to fecal impaction in a pre-coital adolescent.

**Methods:** This is a single case report from a hospital emergency department. The patient was a 12-year-old girl with a 3-day history of acute right lower quadrant abdominal pain (sharp, constant, 8/10 severity, worse with movement) accompanied by constipation, anorexia, and dysuria. She had a history of chronic constipation with encopresis and poor medication adherence. Menarche occurred 10 months prior with regular cycles; last menstrual period was 2 weeks prior. She denied sexual activity or abuse. Vital signs showed tachycardia (HR 108). Physical exam revealed right lower quadrant tenderness with guarding and rebound. Pelvic exam was declined. Laboratory findings included leukocytosis (16,000), elevated absolute neutrophil count, elevated C-reactive protein (5.2), negative urine pregnancy test, and urinalysis suspicious for UTI (pyuria, nitrites). Appendix and pelvic ultrasound showed an unremarkable appendix, fluid-filled uterus, bilateral hydrosalpinges with a complex fluid collection in the left fallopian tube, debris in the bladder, and significant rectal stool burden confirmed on upright x-ray. Contrast CT demonstrated bilateral adnexal hyperemia consistent with salpingitis, bladder distension, endometrial fluid, and mass effect of distended intestine on gynecologic structures.

**Key Results:** The patient's tachycardia resolved with IV hydration and IV ketorolac. Empiric IV doxycycline and ceftriaxone were started for UTI and PID. A Golytely drip via nasogastric tube was initiated for bowel cleanout. Abdominal pain quickly resolved with passage of multiple large volume stools. Gonorrhea and chlamydia testing was negative, so PID antibiotics were stopped. Admission urine culture grew Escherichia coli, and the patient was discharged on oral amoxicillin-clavulanic acid plus a bowel regimen with constipation management education. She remained well with no symptom recurrence. The final primary diagnosis was fecal impaction causing radiographic, noninfectious salpingitis.

**Clinical Implications:** This case demonstrates that fecal impaction can mechanically compress reproductive structures, obstruct normal drainage, and produce sterile inflammation of the fallopian tubes—analogous to the well-recognized mechanism of bladder outlet obstruction from constipation leading to urinary retention and ascending UTI. The authors also hypothesize that translocation of enteric bacteria to adnexal structures may contribute. The case adds to a small literature of pre-coital PID without tubo-ovarian abscess (summarized in a table of 6 prior cases from 2008–2017), though those cases were severe enough to require surgical treatment. Importantly, this patient's rapid improvement with bowel cleanout alone argues that mass effect from impacted feces was the primary cause, not infection. Clinicians should consider constipation in the differential diagnosis of adnexal inflammation in adolescents, even when imaging suggests infectious salpingitis.