Bilateral Vulval Abscess with Pelvic Fistula in ImmunocompromisedPatient with ColostomyA Diagnostic Challenge

Abstract:

This case report presents a 57-year-old female patient with a history of colon

cancer, colostomy, and immunocompromise, who presented with an unusual

bilateral vulval abscess, more prominent on the left side. Due to the atypical

presentation, an MRI was performed, revealing a pelvic collection and a fistulous

connection between the pelvis and vulva. This finding prompted urgent surgical

intervention. This case highlights the diagnostic and therapeutic challenges of

managing complex abscesses and fistulas in immunocompromised patients.

Introduction:

Vulval abscesses in immunocompromised individuals can present with atypical

features and may be associated with complex pathologies. Patients with a history of

cancer, colostomy, and immunocompromise are particularly prone to infections and

may present with unusual manifestations. This report discusses a case of a large

bilateral vulval abscess with an underlying pelvic fistula, emphasizing the

importance of advanced imaging in cases with atypical presentations.

Case Presentation:

A 57-year-old female with a known history of colon cancer, treated with colostomy,

presented with severe pain and swelling in the vulval area. Physical examination

revealed bilateral vulval swelling, with the abscess on the left side appearing larger

and more pronounced than on the right. Given her immunocompromised status and

the unusual nature of the presentation, we requested an MRI of the pelvis,

suspecting an underlying pathology beyond a typical abscess.

Investigations:

MRI imaging revealed a significant pelvic collection and identified a fistulous tract

between the pelvis and the vulva. This confirmed that the vulval abscess was

connected to a deeper pelvic infection, necessitating urgent intervention.

Management:

After consultation with the multidisciplinary team (MDT), it was agreed that the

patient required surgical intervention ,having had 48 hours of antibiotics. The

patient underwent evacuation of the left-sided vulval abscess under spinal

anesthesia. During surgery, the pelvic collection was drained of 200 ml of pus 

Outcome and Follow-Up:

Postoperative recovery was closely monitored due to the patient’s

immunocompromised state. imaging and clinical evaluation showed

improvement in symptoms, with gradual resolution of infection. The patient was

scheduled for regular follow-up visits to monitor for recurrence 

Discussion:

Bilateral vulval abscesses are uncommon and, in an immunocompromised patient,

warrant thorough investigation to rule out deeper infectious or fistulous

connections. This case underscores the utility of MRI in identifying complex

fistulous tracts and highlights the importance of a multidisciplinary approach in

managing such high-risk patients.

Conclusion:

This case illustrates a rare presentation of bilateral vulval abscess with an

associated pelvic fistula