Complication of laparoscopic coagulation of an endometrioma surface

A 32-year-old infertile woman with a 9-cm right ovarian endometrioma with severe adhesions to nearby organs was treated with coagulation of the surface of the endometrioma during laparoscopy. Ultrasonography 6 months later showed a normal pregnancy with an 8-cm ovarian cyst. After a normal delivery at term, while cutting the adhesions on the right side, 200 ml of pus was released, the origin of which was not known. Another endometrioma was present on the left ovary. A drain was inserted into the peritoneal cavity and the operation was completed. Five months later the woman returned with a painful point of redness on the skin of her abdomen. Ultrasonography revealed an 8-week pregnancy. We drained the pus and the patient was discharged. The result of the culture was Escherichia coli. We believe this is a case of intestinal fistula caused by coagulation of the surface of the endometrioma in the first operation.