A 19 year old sexually active female presents to urgent care with abdominal pain and nausea. Her last menstrual period began seven days ago. Physical examination is remarkable for fever and lower abdominal pain. Pelvic examination reveals a mucopurulent discharge, adnexal tenderness, and tenderness with cervical motion. A pregnancy test is negative; the patient's white count is elevated. Which of the following complications is associated with this disorder?

The young woman is suffering from pelvic inflammatory disease (PID). This disorder is classically caused by ascending infection with Neisseria gonorrhoeae or Chlamydia trachomatis. Symptoms include a mucopurulent cervicitis (often producing a vaginal discharge), abdominal pain, or abnormal vaginal bleeding. Fever, an elevated white count, and an elevated erythrocyte sedimentation rate may also be seen. Therapy consists of antibiotics with activity against N. gonorrhoeae, C. trachomatis, vaginal anaerobes and facultative gram- negative rods (e.g., cefoxitin plus doxycycline or clindamycin plus gentamicin). Infeility is a feared complication of tubal scarring and adhesions following salpingitis in PID. Bacteremia, peritonitis, and intestinal obstruction may also complicate this disorder.Abdominal enlargement due to ascites is observed in advanced cases of ovarian carcinoma.Cervical carcinoma is related to infection with ceain subtypes of human papillomaviruses.Exsanguination is a feared complication of a ruptured ectopic pregnancy. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 17. Pathology of the Male and Female Reproductive Tract and Breast. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds),Pathology: The Big Picture.