pelvic inflammatory disease that follows tubal sterilization is very rare and the development of tubo - ovarian stich abscess is even rarer . we describe two such cases of  tubo - ovarian stich abscess a 35-year - old woman presented with a painful palpable mass , in the right lower abdomen since 15 days . patient was treated with intravenous fluids and antibiotics for 7 days at a private hospital , with a diagnosis of appendicular mass , with no response . abdominal examination revealed a tender mass in the right iliac fossa and on pelvic examination , uterus was bulky and there was tenderness in the right fornix of vagina . abdominal ultrasonography showed a hypo - echoic mass lesion 6  5 cm just lateral to the cecum , adherent to the anterior abdominal wall ; the right tube and ovary were congested and thickened ; minimal fluid was present around the mass . diagnostic laparoscopy was carried out , which revealed a mass in the right iliac fossa , where caecum , right fallopian tube , and ovary were densely adherent to the anterior abdominal wall . the appendix was congested and adherent to the mass but was not involved in the mass formation [ figure 1 ] . when we carefully separated the cecum from the anterior abdominal wall , we found a small abscess cavity , in the vicinity of right tube and ovary . along with the pus , we found two loops of sutures in the abscess cavity , which were also removed and sent for culture . patient received injection cefotaxime 1 mg twice a day and injection metrogyl 400 mg 3 times a day , for 5 days . the drain was removed on the 3 post - operative day and the patient was discharged on the 5 post - operative day . the suture culture grew streptococcus intermedius and the histo - pathological findings of appendix showed inflammation in the serosa and subserosal layer with normal mucosa . complex mass involving appendix , cecum , right fallopian tube with embedded suture a 28-year - old woman presented with intermittent fever and pain in the right lower abdomen since 10 days . she was treated with antibiotics and intravenous fluids at a private hospital for 6 days with no response and then was referred to us for further management . abdominal examination revealed a slightly tender mass in the right iliac fossa and pelvic examination revealed bulky uterus and tenderness in the right fornix . abdominal ultrasonography demonstrated a 3  5 cm hypo - echoic mass lesion , supero - lateral to the uterus . diagnostic laparoscopy was carried out , which revealed a complex mass with abscess , in the right iliac fossa , formed by omentum , right tube , ovary , and cecum . omentum was densely adherent to the right tube and ovary and could not be separated . right tubo - ovarian mass involving omentum , right tube and ovary a drain was kept . patient received injection cefotaxime 1 mg twice a day and injection metrogyl 400 mg 3 times , for 5 days . drain was removed on the 2 post - operative day and patient was discharged on the 5 post - operative day . suture culture grew staphylococcus aureus and histo - pathological examination revealed chronic inflammation of the right tube and omentum , with foreign body granuloma , with no evidence of tuberculosis . a 35-year - old woman presented with a painful palpable mass , in the right lower abdomen since 15 days . patient was treated with intravenous fluids and antibiotics for 7 days at a private hospital , with a diagnosis of appendicular mass , with no response . abdominal examination revealed a tender mass in the right iliac fossa and on pelvic examination , uterus was bulky and there was tenderness in the right fornix of vagina . abdominal ultrasonography showed a hypo - echoic mass lesion 6  5 cm just lateral to the cecum , adherent to the anterior abdominal wall ; the right tube and ovary were congested and thickened ; minimal fluid was present around the mass . diagnostic laparoscopy was carried out , which revealed a mass in the right iliac fossa , where caecum , right fallopian tube , and ovary were densely adherent to the anterior abdominal wall . the appendix was congested and adherent to the mass but was not involved in the mass formation [ figure 1 ] . when we carefully separated the cecum from the anterior abdominal wall , we found a small abscess cavity , in the vicinity of right tube and ovary . along with the pus , we found two loops of sutures in the abscess cavity , which were also removed and sent for culture . patient received injection cefotaxime 1 mg twice a day and injection metrogyl 400 mg 3 times a day , for 5 days . the drain was removed on the 3 post - operative day and the patient was discharged on the 5 post - operative day . the suture culture grew streptococcus intermedius and the histo - pathological findings of appendix showed inflammation in the serosa and subserosal layer with normal mucosa . a 28-year - old woman presented with intermittent fever and pain in the right lower abdomen since 10 days . she was treated with antibiotics and intravenous fluids at a private hospital for 6 days with no response and then was referred to us for further management . abdominal examination revealed a slightly tender mass in the right iliac fossa and pelvic examination revealed bulky uterus and tenderness in the right fornix . abdominal ultrasonography demonstrated a 3  5 cm hypo - echoic mass lesion , supero - lateral to the uterus . minimal fluid was present around the mass . diagnostic laparoscopy was carried out , which revealed a complex mass with abscess , in the right iliac fossa , formed by omentum , right tube , ovary , and cecum . omentum was densely adherent to the right tube and ovary and could not be separated . right tubo - ovarian mass involving omentum , right tube and ovary a drain was kept . patient received injection cefotaxime 1 mg twice a day and injection metrogyl 400 mg 3 times , for 5 days . drain was removed on the 2 post - operative day and patient was discharged on the 5 post - operative day . suture culture grew staphylococcus aureus and histo - pathological examination revealed chronic inflammation of the right tube and omentum , with foreign body granuloma , with no evidence of tuberculosis . pelvic inflammatory disease and development of tubo - ovarian abscess ( toa ) has long been regarded as an uncommon rare complication following tubal sterilization and tubo - ovarian stitch abscess is even rare . the predominant theory on toa formation postulates that an ascending infection from the cervix , through the uterus , to the fallopian tubes , and ovaries results in abscess formation . toas are polymicrobial infections of anaerobic and aerobic bacteria . while neisseria gonorrhea and chlamydia trachomatis are thought to facilitate the infection , they are rarely recovered from an abscess . staphylococcus epidermidis is frequently part of the normal vaginal flora but s. aureus is associated with serious hospital - acquired infections such as post - operative wound abscesses . forty - five percentages of patients who were surgically treated for toa , suffered from a unilateral abscess . toas that occurred as a complication of a gynecologic operation or after delivery were mostly unilateral and they are more common in nullipara . setting , following gynecological surgery , symptoms of toa appear between 6 and 133 days and even after 7 years . a single strand of absorbable suture material ( 1 - 0 catgut ) is recommended for tubal ligation , but in some of the hospitals , surgeons still are using non - absorbable suture material for tubal ligation , which is not recommended . patient - to - patient transmission of hiv in private surgical consulting rooms by re - use of suture material has been described by chant et al . non - absorbable sutures are made of materials , which are not metabolized by the body . capability of bacteria to adhere to various types of sutures has a significant effect on their ability to cause infections . nylon bound the least bacteria while bacterial adherence to braided sutures ( silk , cotton thread ) was 5 to 8 folds higher . s. aureus is known to cause other chronic indolent infections even after pelvic surgeries like cesarean section and tubal ligation , which last many years . we may speculate that in our cases the micro - organisms might have gained access to the patients right adnexa via contaminated suture material during tubal ligation or re - use of suture or gloves and have caused a subacute formation of pelvic abscess . re - use of suture material is not recommended and sterile absorbable suture like catgut should be used for tubal ligation .
tubo - ovarian abscess usually results from ascending infection of the lower genital tract . in few cases , 
 it can occur as a result of direct contamination at the time of tubal sterilization . 
 we describe two rare cases of  tubo - ovarian stitch abscess  after post - partum tubal sterilization and managed successfully by laparoscopy at a tertiary care teaching hospital .