The Hidden Danger in Endometriosis: Bilateral Pelvic Abscesses Following Fertility Treatment

Diya E Viju, Diana George, Sandesh Kade, Vipin Dagar, Rojan Kuruvilla, Robin M Kuruvilla, R. P. Das, Ranjita Das
Cureus · 2025 · vol. 17(6) , pp. e86707 · doi:10.7759/cureus.86707 · PMID:40718173 · PMC12295536 · W4411656957
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This case report describes how advanced imaging identified bilateral tubo-ovarian abscesses following IVF in a patient with endometriosis, highlighting the diagnostic challenge and the importance of radiology in managing rare ART complications.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This 2025 case report describes a 34-year-old woman with long-standing endometriosis and secondary infertility who developed bilateral tubo-ovarian abscesses after IVF/ART, following a missed abortion and continued hormonal support. Using a multimodal diagnostic workup—transvaginal ultrasound, contrast-enhanced CT, and pelvic MRI—the authors found multiloculated enhancing adnexal collections consistent with superimposed infection on chronic hemorrhagic adnexal disease, with persistent systemic inflammation (very high CRP and leukocytosis) and a differential that initially included appendicitis and PID. Emergency diagnostic laparoscopy confirmed TOA on the left and hematopyosalpinx on the right, and the patient improved rapidly postoperatively with marked normalization of inflammatory markers; the main limitation is that the evidence is limited to a single case. This paper is centrally about endometriosis — it reports bilateral tubo-ovarian abscesses arising as a rare, imaging-guided infectious complication on a background of endometriosis after fertility treatment.

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Abstract

This case report underscores the crucial role of imaging and radiology in the timely diagnosis of a rare but serious complication associated with assisted reproductive technology (ART). A 34-year-old woman with a long-standing history of endometriosis and secondary infertility developed bilateral tubo-ovarian abscesses (TOAs) following in vitro fertilization (IVF). Her presentation included nonspecific gastrointestinal and pelvic symptoms that delayed diagnosis. However, a multimodal imaging approach, combining transvaginal ultrasound, contrast-enhanced computed tomography (CT), and pelvic magnetic resonance imaging (MRI), proved critical in identifying a superimposed infection on chronic adnexal disease. Subsequent surgical exploration confirmed the diagnosis of TOA and hematopyosalpinx. This case illustrates the diagnostic complexity of differentiating infectious processes from endometriotic flare-ups in the post-ART setting and highlights the indispensable role of early and advanced imaging in guiding clinical management, preventing sepsis, and preserving fertility.

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Condition tags

endometriosisinfertility

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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