Chocolate cyst became ovarian abscess following IVF: a serious surgical emergency

Poonam Yadav, Namita Agrawal, S. M. R. Zaidi, S. Fayyaz
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2018 · vol. 7(5) , pp. 2052 · doi:10.18203/2320-1770.ijrcog20181956 · W2802721305
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This case report describes a giant ovarian abscess forming within an endometrioma after in vitro fertilization oocyte retrieval, requiring surgical intervention and bilateral salpingo-oophorectomy.

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This paper reports a rare case of a giant ovarian abscess that developed within an endometrioma after ultrasound-guided oocyte retrieval for IVF in a 36-year-old woman with secondary infertility. The patient experienced high-grade fever with chills and rigor for over two months along with progressive lower abdominal pain and a growing mass, and was managed with a multidisciplinary approach; laparotomy drained about two liters of foul-smelling pus and included bilateral salpingoophorectomy, with the uterus left in place for future fertility potential, and histology confirmed an endometriotic cyst. Although pus culture sensitivity was sterile, the paper highlights endometrioma as both a cause of IVF failure and a presentation as a medical illness requiring urgent surgical management. This paper is centrally about endometriosis — specifically an endometrioma complicated by ovarian abscess following IVF.

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Abstract

We are reporting a rare case of ovarian abscess in an endometrioma following ultrasound guided oocyte retrieval during in vitro fertilization technique. Ovarian abscess within an endometrioma is a rare gynaecological problem. We are presenting a case of a giant abscess formation in an endometrioma following in vitro fertilization in a 36-year-old woman in view of secondary infertility. She presented with high grade fever with chills and rigor for more than 2 months associated with pain in abdomen with a progressively increasing lower abdominal mass. Patient was treated at a tertiary care hospital with multidisciplinary approach. Laparotomy was performed, and two litres of the foul-smelling pus was drained, followed by bilateral salpingooophorectomy. Uterus was left in situ to preserve her future fertility potential. Histology of the specimen confirmed endometriotic nature of the cyst. Pus on culture sensitivity was sterile. Patient had an uneventful recovery and was discharged on the 7th post-operative day. In our case endometrioma presented as failure of in vitro fertilization technique followed by a medical illness. This case highlights that endometrioma became not only a cause of failure of in vitro fertilization technique but also presented as a medical illness and should be dealt as one.
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Chocolate cyst became ovarian abscess following IVF: a serious surgical emergency DOI: https://doi.org/10.18203/2320-1770.ijrcog20181956Keywords: Bilateral salpingoophorectomy, Endometrioma, In vitro fertilization technique, Ovarian abscess, Secondary infertility, Ultrasound guided oocyte retrievalAbstract We are reporting a rare case of ovarian abscess in an endometrioma following ultrasound guided oocyte retrieval during in vitro fertilization technique. Ovarian abscess within an endometrioma is a rare gynaecological problem. We are presenting a case of a giant abscess formation in an endometrioma following in vitro fertilization in a 36-year-old woman in view of secondary infertility. She presented with high grade fever with chills and rigor for more than 2 months associated with pain in abdomen with a progressively increasing lower abdominal mass. Patient was treated at a tertiary care hospital with multidisciplinary approach. Laparotomy was performed, and two litres of the foul-smelling pus was drained, followed by bilateral salpingooophorectomy. Uterus was left in situ to preserve her future fertility potential. Histology of the specimen confirmed endometriotic nature of the cyst. Pus on culture sensitivity was sterile. Patient had an uneventful recovery and was discharged on the 7th post-operative day. In our case endometrioma presented as failure of in vitro fertilization technique followed by a medical illness. This case highlights that endometrioma became not only a cause of failure of in vitro fertilization technique but also presented as a medical illness and should be dealt as one. Metrics References Acién P, Velasco I. Endometriosis: A disease that remains enigmatic. ISRN Obstetrics Gynecol. 2013;2013:242149. Shah PR, Adlakha A. Laparoscopic management of moderate: Severe endometriosis. Jf Minimal Access Surgery. 2014;10(1):27-33. Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology. Endometriosis. 3rd edition. United states of America; McGraw-Hill education; 2016;10:230-248. Senapati S, Barnhart K. Managing endometriosis associated infertility. Clin Obst Gynecol. 2011;54(4):720-6. Kelada E, Ghani R. Bilateral ovarian abscesses following transvaginal oocyte retrieval for IVF: a case report and review of literature. J Assisted Reprod Genetics. 2007;24(4):143-5. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s lives: a qualitative study. BMC Women’s Health. 2014;14:123. Hameed A, Mehta V, Sinha P. A rare case of de novo gigantic ovarian abscess within an endometrioma. Yale J Biol Med. 2010;83(2):73-5. Kubota T, Ishi K, Takeuchi H. A study of tubo-ovarian and ovarian abscesses, with a focus on cases with endometrioma. J Obstet Gynaecol Res. 1997;23:421-6. Shah, Rameshvari C, Shah JM, Mehta MN. Laparoscopic management of an endometrioma complicated by an ovarian abscess. Int J Reprod Contracept Obstet Gynecol. 2013;2(3):473-4.

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