(112) Variable Outcomes of Adolescent Hydrosalpinx: A Case Series of 3 Postmenarchal Nonsexually Active Patients

Background: Hydrosalpinx has been reported in adolescents, though data is limited. Adolescents who are not sexually active may have unique etiologies compared to adults. Management strategies remain inconclusive for this age group. We present three cases of hydrosalpinx in postmenarchal, non-sexually active adolescents.

Case: A 14 year-old G0 with severe depression presented with dysmenorrhea unrelieved by NSAIDs. Initial trial of oral contraceptive pills (OCP) was discontinued for worsening mood symptoms. Transabdominal ultrasound (TAUS) revealed right hydrosalpinx. Pain resolved with menstrual suppression using a different OCP. At 3 month follow-up, TAUS showed resolution. A 12 year-old G0 without significant medical history presented with two episodes of spontaneously resolving acute onset left lower quadrant abdominal pain. TAUS revealed left hydrosalpinx and a follow-up pelvic MRI demonstrated a septate uterus with a left hydrosalpinx. At a 3 month follow-up, her pain resolved, however the hydrosalpinx persisted on repeat TAUS. A 15 year-old G0 with Ehlers-Danlos syndrome and urinary incontinence presented with fevers and right flank pain. Though initially diagnosed as pyelonephritis, TAUS revealed a right tubo-ovarian abscess. CT-guided drain was placed, cultures grew E. coli, and antibiotics were started. Based on interval imaging after hospital discharge, hydrosalpinx decreased in size but did not resolve. Patient was readmitted 4 months later for recurrent right tubo-ovarian abscess not amenable to IR drainage, requiring a right salpingectomy. Patient represented 7 months later with left back and lower quadrant abdominal pain. She was found to have a left tubo-ovarian abscess not amenable to IR drainage, requiring a left salpingectomy. Cultures grew Klebsiella.

Comments: Consistent with previous literature, acute abdominal pain is often a presenting symptom of hydrosalpinx. Dysmenorrhea should also prompt consideration of this diagnosis. Literature suggests adolescent hydrosalpinx may stem from congenital anomalies rather than STIs. Our cases involved non-sexually active patients with one suspected uterine anomaly which may be associated with tubal pathology. Management of adolescent hydrosalpinx remains uncertain, with variable outcomes in non-surgical treatment. Despite symptom resolution in both patients who opted for non-surgical management, one had persistent hydrosalpinx on imaging. Thus, treatment should be driven by symptoms and patient-preference. Further research is essential for guiding diagnosis and management strategies.