A case of ovarian endometriotic cysts with chronic ovarian abscesses found at surgery and showing symptoms of severe infection after surgery

Kazuma Tagami, Hiroki Kurosawa, Tadashi Watanabe, Naoto Sato, Haruo Murakawa, Yuma Muraoka, T. Nakanishi, Yoh Watanabe
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(1) , pp. 97–103 · doi:10.5180/jsgoe.38.1_97 · W4285308506
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This case report describes a patient with ovarian endometriosis who developed chronic ovarian abscesses during surgery and experienced severe postoperative inflammation, highlighting risks for patients undergoing assisted reproductive techniques.

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This case report describes a 42-year-old woman with infertility who underwent laparoscopic myomectomy and left ovarian cystectomy for uterine fibroids and asymptomatic endometriotic cysts. Intraoperative findings revealed that the endometriotic cysts had developed into chronic ovarian abscesses, which were treated via fenestration and irrigation during the procedure. Despite these interventions, the patient experienced severe postoperative inflammatory symptoms, indicating latent clinical deterioration associated with the infected lesions. This paper is centrally about endometriosis — specifically, it documents a rare complication where endometriotic cysts transform into chronic ovarian abscesses leading to severe post-surgical infection.

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Abstract

We report a case of asymptomatic ovarian abscesses developed from ovarian endometriosis in a woman with infertility. A 42-year-old married woman presented to our hospital on referral from an in vitro fertilization clinic for enucleation of uterine fibroids. Ovarian endometriotic cysts were also present, which could be considered a cause of infertility. Having undergone oocyte retrieval and embryo transfer several times, she had no evidence of pelvic infection. Laparoscopic myomectomy and left ovarian cystectomy were performed. During surgery, findings in the left adnexa suggested that the ovarian endometriotic cysts had developed chronic ovarian abscesses. Although fenestration and irrigation of the abscesses was performed, the patient had symptoms of severe inflammation after surgery. This case suggests that latent clinical deterioration may occur in patients with ovarian abscesses. Therefore, careful preoperative diagnosis and postoperative management are needed in patients who have undergone assisted reproductive techniques.
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症例報告 手術時に卵巣膿瘍の合併が判明し術後に重度の感染徴候を示した内膜症性嚢胞の１例 2022 年 38 巻 1 号 p. 97-103 詳細 抄録 We report a case of asymptomatic ovarian abscesses developed from ovarian endometriosis in a woman with infertility. A 42-year-old married woman presented to our hospital on referral from an in vitro fertilization clinic for enucleation of uterine fibroids. Ovarian endometriotic cysts were also present, which could be considered a cause of infertility. Having undergone oocyte retrieval and embryo transfer several times, she had no evidence of pelvic infection. Laparoscopic myomectomy and left ovarian cystectomy were performed. During surgery, findings in the left adnexa suggested that the ovarian endometriotic cysts had developed chronic ovarian abscesses. Although fenestration and irrigation of the abscesses was performed, the patient had symptoms of severe inflammation after surgery. This case suggests that latent clinical deterioration may occur in patients with ovarian abscesses. Therefore, careful preoperative diagnosis and postoperative management are needed in patients who have undergone assisted reproductive techniques. © 2022 日本産科婦人科内視鏡学会

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