Our Summary

A 43-year-old woman came to the hospital with increasing pain and swelling in the lower right side of her abdomen. She had a history of having her fallopian tubes tied (bilateral tubal ligation) and ovarian cysts. Her symptoms, which included vaginal discharge and pain when her cervix was moved during an examination, and a very high white blood cell count, suggested she had a condition called pelvic inflammatory disease (PID). This is usually caused by sexually transmitted infections, but tests for two common ones, Chlamydia and Gonorrhoea, were negative. Instead, her blood tests showed she had an infection caused by a type of bacteria called group A Streptococcus. This is a very severe case of PID, and it’s unusual for it to be caused by this bacteria, especially as the woman had had her tubes tied. This made it a challenging case to treat, and the decision-making process was guided by an extensive review of medical literature. This case report highlights the important role of family doctors in managing complex cases like this in community hospitals.

FAQs

  1. Can pelvic inflammatory disease (PID) occur after bilateral tubal ligation?
  2. What unusual laboratory findings were seen in this case of PID after bilateral tubal ligation?
  3. How did the primary family medicine team contribute to the management of this complex PID case?

Doctor’s Tip

One helpful tip a doctor might tell a patient about bilateral tubal ligation is to be aware of the potential risks of developing pelvic inflammatory disease (PID) and to seek medical attention if experiencing symptoms such as lower abdominal pain, abnormal vaginal discharge, or fever. Regular follow-up appointments and communication with a healthcare provider can help monitor for any complications and ensure prompt treatment if necessary.

Suitable For

Patients who are typically recommended bilateral tubal ligation are those who have completed their desired family size and wish to permanently prevent pregnancy. This procedure is often recommended for women who have medical conditions that make pregnancy risky, who have a high risk of passing on genetic disorders, or who simply do not wish to have any more children. In some cases, bilateral tubal ligation may also be recommended as a treatment for certain gynecological conditions, such as severe pelvic inflammatory disease.

Timeline

Before bilateral tubal ligation:

  1. Patient consults with OB/GYN about permanent birth control options.
  2. Patient decides on bilateral tubal ligation as the preferred method.
  3. Patient undergoes pre-operative consultations and tests.
  4. Patient undergoes bilateral tubal ligation procedure.

After bilateral tubal ligation:

  1. Patient experiences post-operative pain and discomfort.
  2. Patient may have some vaginal bleeding or discharge.
  3. Patient recovers at home for a few days to a week.
  4. Patient returns to normal activities with no risk of pregnancy.
  5. Patient may experience changes in menstrual cycle or hormone levels.
  6. Patient follows up with OB/GYN for post-operative care and monitoring.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with bilateral tubal ligation surgery?
  2. How effective is bilateral tubal ligation in preventing pregnancy?
  3. Are there any long-term effects on hormone levels or menstrual cycle after undergoing bilateral tubal ligation?
  4. Is it possible to reverse a bilateral tubal ligation if I change my mind in the future about wanting to have children?
  5. How soon after the surgery can I resume normal activities and exercise?
  6. Will bilateral tubal ligation affect my sexual function or libido?
  7. Are there any lifestyle changes or precautions I should take after undergoing bilateral tubal ligation?
  8. How often should I follow up with my doctor after the surgery to ensure everything is healing properly?
  9. Are there any specific symptoms or signs I should watch out for that may indicate a complication after bilateral tubal ligation?
  10. Are there any alternative methods of permanent contraception that I should consider before deciding on bilateral tubal ligation?

Reference

Authors: Wolfenden E, Mittal M, Sussman R. Journal: BMJ Case Rep. 2020 Oct 27;13(10):e236326. doi: 10.1136/bcr-2020-236326. PMID: 33109694