Tubo-ovarian abscess in a young child with suspected Prader–Willi syndrome: a complication of childhood obesity

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–Willi 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 Group A Streptococcus. 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.