Background: Although pelvic inflammatory disease can be seen after tubal occlusion, tuboovarian abscess is rare, with only 38 cases reported since 1975 [1]. The differential diagnosis of tuboovarian abscess after tubal occlusion should include non-infectious and non-gynecologic etiology, particularly as women age [2]. Case: A 40 year old multiparous woman with a distant history of tubal occlusion, presented with pelvic pain and suspected right tuboovarian abscess with air on CT scan. A colonic stricture was also seen, warranting further evaluation, which revealed a left tuboovarian abscess which had fistulized from a bowel perforation secondary to colorectal cancer. Conclusion: Tuboovarian abscess is rare after tubal occlusion. These patients should be evaluated specifically for nongynecologic etiology, including colorectal cancer. Radiologic studies can be misleading, and surgical exploration should be strongly considered if a woman with a history of tubal occlusion presents with a presumptive tuboovarian abscess, particularly if the abscess contains air.