{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T02:06:40Z","timestamp":1769566000550,"version":"3.49.0"},"reference-count":11,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Tubo-ovarian abscess (TOA) is an exceptionally rare diagnosis in prepubertal girls and typically arises through mechanisms distinct from pelvic inflammatory disease. We report the case of a girl in her early childhood with severe obesity and clinical features suggestive of Prader\u2013Willi syndrome who presented with acute abdominal pain and systemic sepsis. Diagnostic laparoscopy was undertaken for suspected perforated appendicitis and revealed a ruptured TOA caused by\n                    <jats:italic>Group A Streptococcus<\/jats:italic>\n                    . Surgical drainage and targeted antimicrobial therapy resulted in complete recovery. This case highlights the diagnostic challenges of acute abdominal pain in young children, the importance of maintaining a broad differential diagnosis, and the possibility that syndromic obesity may predispose to atypical and severe infections.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-270118","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:45:12Z","timestamp":1769517912000},"page":"e270118","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Tubo-ovarian abscess in a young child with suspected Prader\u2013Willi syndrome: a complication of childhood obesity"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0113-6834","authenticated-orcid":false,"given":"Tanya","family":"Bhalla","sequence":"first","affiliation":[{"name":"General Surgery, Glangwili General Hospital, Carmarthen, UK"},{"name":"General Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Flynn","sequence":"additional","affiliation":[{"name":"General Surgery, Glangwili General Hospital, Carmarthen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pia Florentina","family":"Smit","sequence":"additional","affiliation":[{"name":"General Surgery, Glangwili General Hospital, Carmarthen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Kenneth","family":"Harries","sequence":"additional","affiliation":[{"name":"General Surgery, Glangwili General Hospital, Carmarthen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"2026012704450599000_19.1.e270118.1","first-page":"937","article-title":"Tubo-ovarian abscess: pathogenesis and management","volume":"78","author":"Osborne","year":"1986","journal-title":"J Natl Med Assoc"},{"key":"2026012704450599000_19.1.e270118.2","doi-asserted-by":"crossref","unstructured":"Bridwell RE . High risk and low prevalence diseases: tubo-ovarian abscess and associated risk factors. Clin Rev 2022.","DOI":"10.1016\/j.ajem.2022.04.026"},{"key":"2026012704450599000_19.1.e270118.3","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2022.958210","article-title":"Antibiotic Resistance and Mechanisms of Pathogenic Bacteria in Tubo-Ovarian Abscess","volume":"12","author":"Tang","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"2026012704450599000_19.1.e270118.4","unstructured":"Jackson D , Gould S , Reichard K , et al . Tubo-ovarian abscess in non-sexually active girls: a case series. Pediatr Radiol 2016."},{"key":"2026012704450599000_19.1.e270118.5","doi-asserted-by":"crossref","first-page":"e100","DOI":"10.1097\/PEC.0000000000000753","article-title":"Streptococcus constellatus Tubo-ovarian Abscess in a Non-Sexually Active Adolescent Female","volume":"34","author":"Mills","year":"2018","journal-title":"Pediatr Emerg Care"},{"key":"2026012704450599000_19.1.e270118.6","doi-asserted-by":"crossref","unstructured":"Fang X , Henao-Mejia J , Henrickson SE . Curr Opin Pediatr. Front Pediatr 2020;805\u201315. doi:10.1097\/MOP.0000000000000953","DOI":"10.1097\/MOP.0000000000000953"},{"key":"2026012704450599000_19.1.e270118.7","unstructured":"Pugliese G , Liccardi A , Graziadio C , et al . Obesity and infectious diseases: pathophysiology and immune dysfunction. Nat Rev Endocrinol 2022."},{"key":"2026012704450599000_19.1.e270118.8","doi-asserted-by":"crossref","unstructured":"Cassidy SB , Driscoll DJ . Prader\u2013Willi syndrome: clinical genetics and phenotype. Nat Rev Dis Primers 2012. doi:10.1097\/GIM.0b013e31822bead0","DOI":"10.1097\/GIM.0b013e31822bead0"},{"key":"2026012704450599000_19.1.e270118.9","unstructured":"Butler MG , Miller JL , Forster JL . n.d. Genetic Testing in Prader\u2013Willi Syndrome and Obesity. Clin Genet."},{"key":"2026012704450599000_19.1.e270118.10","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1002\/nau.24669","article-title":"High prevalence of lower urinary tract dysfunction in patients with Prader-Willi syndrome","volume":"40","author":"Chao","year":"2021","journal-title":"Neurourol Urodyn"},{"key":"2026012704450599000_19.1.e270118.11","unstructured":"Hashemian H , Kaser S . Childhood obesity, immune dysfunction, and infection risk. J Clin Pediatr 2017."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270118","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:45:20Z","timestamp":1769517920000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,27]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-270118"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270118","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}