Barw Barw Medical Journal 2960-1959 3 3 2025 06 24 Suture-Induced Tubo-Ovarian Abscess: A Case Report with Literature Review 56 61 10.58742/bmj.v3i3.190 eng Huda M. Muhammad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. huda.muhammed@univsul.edu.iq Nahida Hama Ameen Ahmed Obstetrics and Gynecology Department, Sulaimani Maternity Teaching Hospital, Sulaymaniyah, Iraq. nahida.ahmed@gmail.com Sawen M. Ahmed Obstetrics and Gynecology Department, Shawkat Haji Musheer Hospital, Said Sadiq/Sulaymaniyah, Iraq. sawen.ahmed@gmail.com Zhiyan M. Mohammed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. zhian.mohammed@gmail.com Meer M. Abdulkarim Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. meermohammedabdulkarim@gmail.com Rawa M. Ali Hospital for Treatment of Victims of Chemical Weapons, Halabja, Iraq. rawa.ali@gmail.com Nsren S. Sabr Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. nsren.sabr@gmail.com Omar HG. Hawramy Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. omer.hawrami@gmail.com Sakar O. Arif Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sakar.arif@gmail.com Lania Aso Abdullah Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. lania.abdullah@gmail.com Media Adel Ali Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. media.ali@gmail.com Shno J. Jabbar Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. shno.jabar@gmail.com Ahmed Gh. Hamasaeed Faculty of Medical Sciences, School of Pharmacy, University of Sulaimani, Sulaymaniyah, Iraq. ahmed.saeed@gmail.com Ali D. Sadullah Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. Ali.mobasheri@gmail.com 2025 04 30 Introduction Suture is an underreported cause for tubo-ovarian abscess (TOA) that can cause significant morbidity. This report describes a case of TOA arising from a silk suture three years after bilateral tubal ligation. Case presentation A 38-year-old woman with a history of tubal ligation presented with persistent pelvic pain and fever. Imaging revealed a suspicious left adnexal mass with features concerning for malignancy or abscess. Surgical exploration revealed a TOA adherent to surrounding structures, containing a retained silk suture from prior surgery. The abscess and suture were removed, and histopathology confirmed chronic inflammation without malignancy. The patient underwent additional procedures for thorough management, including polypectomy and contralateral tubal ligation. Literature Review A total of nine cases of TOAs and suture-induced abscesses were reviewed. Of these, seven were TOAs, six of which occurred postoperatively. Three cases developed following tubal ligation procedures. The abscesses ranged in size from 1 to 7.6 cm. The interval between the presumed inciting event and abscess detection varied widely, with one case presenting more than three decades after surgery. Isolated microorganisms included Escherichia coli, Streptococcus pyogenes, and Peptostreptococcus anaerobius. All patients underwent surgical intervention via various approaches, and several also received adjunctive antibiotic therapy. Conclusion Suture-induced TOA following sterilization may result in considerable morbidity, and surgical intervention may provide favorable outcomes.