Exploratory surgery in December 2023 provided an answer – one that so astonished Summerlin’s doctors that they summoned a colleague from another operating room to see what they had found. Their discovery led to the eradication of Summerlin’s illness and possibly explained other ailments she had suffered.

“I’m so grateful,” Summerlin said. “I feel like this is over.”

Frightening birth

In the fall of 2013, Summerlin, then 31 and living in Florida, learned she was 10 weeks’ pregnant. Her daughter was born in June 2014, two weeks after her due date.

Although Summerlin said “the pregnancy went really well,” the delivery did not.

Hospital records show the presence of cephalopelvic disproportion, a mismatch between the size of the mother’s pelvis and the head of the fetus, who in this case weighed nearly 5kg. During her labour, doctors detected signs of fetal distress: Summerlin’s amniotic fluid was stained with greenish meconium – stool that can cause lung problems if the infant inhales it.

Shortly after delivery Summerlin, who developed a low-grade fever, was told that her baby had suffered a displaced hip, which would require her to wear a corrective brace for several months. The pathology examination of the placenta revealed severe chorioamnionitis, a serious bacterial infection of the membranes that surround the fetus as well as funisitis, inflammation of the umbilical cord that can accompany chorioamnionitis.

Mother and daughter received antibiotics and were discharged about 48 hours after delivery.

On her second night home, Summerlin developed shaking chills, a fever of more than 38C and abdominal pain, all signs of serious infection.

“Every day I called [the obstetrics practice] and talked to someone different, and they gave me a different explanation,” Summerlin recalled. She made several office visits and was prescribed a variety of antibiotics, but the episodic chills and other symptoms lingered.

“A week later I called and got the original doctor, and he said, ‘Are you still having problems? Come to the hospital right now,’” she remembered.

Summerlin, who was admitted, said she felt “terrified. I had a brand new baby at home who couldn’t be with me”.

A CT scan revealed an abscess on the lower right side of her abdomen. The following day Summerlin underwent a procedure to drain it. Laboratory cultures found group B strep, which can have serious consequences for newborns, including blood and lung infections. Women are supposed to be screened for strep at the end of pregnancy; if they test positive they should receive antibiotics during labour. Summerlin said she doesn’t know if she was tested or given antibiotics then.

Despite treatment of the abscess, her pain did not improve. The fluid in her abdomen increased, she developed a fast heartbeat and shortness of breath, and her fever rose to 39C. Doctors decided to open her C-section incision to perform exploratory surgery and a washout, a procedure used to treat infection.

They also took out Summerlin’s appendix. “They told me they did this just in case,” she recalled. Doctors later determined that her appendix was neither inflamed nor the reason for her infection.

Summerlin was ultimately diagnosed with a post-Caesarean wound infection that resulted in intra-abdominal sepsis with purulent peritonitis – a pus-producing infection of the abdominal lining. Sepsis is a leading cause of maternal mortality.

She spent six days in the hospital, much of it in the ICU. “All the planning I had about breastfeeding and attachment all went out the window,” she said. “I was fighting to survive just to see my daughter grow up.”

Although she recovered from the ordeal, Summerlin said she didn’t “feel good for a couple of years,” which she largely attributed to other factors. “I was going through a divorce, and there was constant illness from my daughter’s daycare.”

A few years after her daughter was born, Summerlin, who had not previously experienced digestive problems, was diagnosed with irritable bowel syndrome marked by diarrhoea and constipation, which was sometimes severe and long-lasting. She also developed what appeared to be periodic yeast and urinary tract infections.

“I thought maybe my immune system was a bit weaker because of all the antibiotics I had to be on after giving birth,” she said.

A baffling infection

In late 2022, Summerlin, who moved to Washington in 2016 and was working as a lawyer for the Federal Education Association, a union that represents teachers who work in Defence Department schools, developed what she thought was a yeast infection. At first she treated it with her usual assortment of over-the-counter remedies.

When her symptoms didn’t improve, she consulted her primary care doctor at Kaiser Permanente who didn’t see evidence of a yeast infection and referred her to a gynaecologist. The gynaecologist ordered cultures that failed to pinpoint a bacterial or fungal infection. In March 2023, she began seeing Kaiser OB/GYN Ariel Cohen.

“I remember hearing this rather terrifying story about her delivery,” said Cohen, referring to the history he took during Summerlin’s initial appointment. He noted that despite some symptoms of a possible yeast infection, cultures again found no identifiable cause. Her symptoms eventually disappeared.

But one morning in September 2023, Summerlin woke up with severe abdominal pain, pressure and a distended stomach. She went to a Kaiser urgent care centre near her Maryland home; tests revealed a high white blood cell count. Doctors suspected pelvic inflammatory disease (PID), an infection of the reproductive organs that is traditionally associated with sexually transmitted diseases, including gonorrhoea and chlamydia. But Summerlin’s tests were repeatedly negative.

Although sexually transmitted infections are often the cause of PID, the disease can result from gastrointestinal bacteria that invades the reproductive tract, Cohen noted.

An abdominal ultrasound and CT scan revealed a left-sided mass that indicated a possible tubo-ovarian abscess, a type of PID that affects the fallopian tubes and ovaries and sometimes can cause inflammation of the nearby bowel or bladder.

She was given antibiotics, her condition improved, and after an overnight stay at urgent care she went home.

In October, at Cohen’s recommendation Summerlin’s IUD, which had been inserted years earlier, was removed in an effort to reduce the chance of a future infection.

In early November, hours after her hearing before a Senate subcommittee, the severe pain and swollen abdomen recurred. Summerlin spent 48 hours at a Kaiser urgent care centre where she was treated with antibiotics. Her planned transfer to a hospital was cancelled when her condition improved.

“They said you can’t keep coming back,” she recalled of her conversations with the urgent care doctors. Her white blood cell count was high, and a scan detected fluid in her fallopian tubes.

Other than antibiotics, the other option was exploratory surgery to determine what was causing the infections. Without it, Summerlin said, “I was really worried this would come back every five or six weeks”. Surgery, she decided, was her only real choice.

“She was really clear that this was so disruptive to her life,” Cohen said. “She wanted surgery, and I recommended it.”

Uncertain about what an operation might uncover, Cohen said he sought to ensure that the requisite experts were present in the operating room.

“What starts as a routine laparotomy [exploratory surgery]” he noted, “can end with a colostomy bag”.

Cohen enlisted surgeon Alyssa Small Layne who specialises in laparoscopic gynaecological procedures. A general surgeon was added in case Summerlin needed an immediate abdominal or bowel procedure.

Before the operation Cohen said he and his colleagues speculated that Summerlin might be suffering from a long-standing problem related to her 2014 C-section.

“What we thought and what we found were very different,” he said.

Surgeons ‘literally gasped’

Summerlin remembers being wheeled into surgery at Maryland’s Holy Cross Hospital on December 29 last year “in tears and terrified”. She worried doctors might not be able to operate laparoscopically, which would entail a longer and more difficult recovery that would complicate taking a new job. (Her nomination is still pending and may be voted on after the November election.)

Summerlin said she was enormously relieved when she discovered in the recovery room that her surgery had been minimally invasive. Cohen told her the operation had gone well and that she was being discharged later that day. Her right ovary and both fallopian tubes had been removed, he told her.

So had her appendix.

Cohen said that the trio of surgeons “literally gasped” when they saw that a segment of the appendix, which was supposed to have been removed in its entirety in 2014, was firmly attached to Summerlin’s right ovary and was leaching its contents, including liquefied faeces, into her fallopian tubes. (Faeces can sometimes become trapped in the appendix, which is shaped like a tube.)

“It was very much connected to stuff it should not be connected to,” Cohen said of the appendix segment. “We were all just kind of gawking at it.”

Summerlin remembers that her doctors “told me there is no such thing as a partial appendectomy. No one could think of a reason for this”.

A “remnant” appendix is rare – just how rare is unclear. Failure to remove all of the appendix can result in stump appendicitis – acute inflammation and infection caused by the leftover appendix.

Cohen said he believes the remaining appendix had caused Summerlin’s PID. “This thing was inflamed the whole time,” he said.

The discovery, Cohen said, left him with numerous unanswered questions: Why did doctors perform an appendectomy in the first place? Did they leave a portion of the organ behind because they couldn’t see it “in the context of a very infected abdomen?” And how had it gone undetected for nearly a decade without causing more serious infection much sooner?

There had been a possible clue, Cohen noted. A CT scan performed in September 2023 showed no appendix, while a repeat scan two months later reported “appendix visualised”.

In the 10 months since her 2023 operation, Summerlin has been infection-free and her IBS has disappeared.

Because so much time has elapsed since her 2014 appendectomy, Summerlin said she doubts she’ll ever know what went wrong. She said she considered filing a malpractice lawsuit – an action that can sometimes provide patients with information – but the statute of limitations has passed.

“I’m not a litigious person,” she said, “but I’d like to get some answers. Was it a whoopsie moment?”

Summerlin said she is “very grateful” to her Kaiser doctors, particularly Cohen, whose efforts liberated her from the unexplained and painful infections that marked the past decade.

“It’s a bit of a horror to think that I had this Franken-thing in my body for almost 10 years,” she said.

Sandra G Boodman, who was a Washington Post staff writer for more than 30 years, created the Medical Mysteries column.