Septic shock after a saline infusion hysterosalpingosonogram in a woman with stage IV endometriosis and infertility: A case report

Mariah Colussi, Geneviève Horwood, Jenn McCall, James McCall, Jenna Gale, Sukhbir Singh, Sukhbir S. Singh
Case reports in women's health · 2024 · vol. 44 , pp. e00663 · doi:10.1016/j.crwh.2024.e00663 · PMID:39611107 · W4404135120
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This case report describes a woman with stage IV endometriosis who developed severe pelvic infection and septic shock after a saline infusion sonohysterogram, highlighting the increased risk and potential need for antibiotic prophylaxis.

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Abstract

Saline infusion sonohysterography/hysterosalpingo-contrast sonography is commonly used in the work-up of infertility. Overall, the risk of pelvic infection following these investigations is rare, but may be increased in patients with deep infiltrating endometriosis. Antibiotic prophylaxis is not professionally recommended in patients with advanced endometriosis, a point that requires reconsideration. A 29-year-old woman with stage IV endometriosis presented with pelvic inflammatory disease and sepsis following a saline hysterosalpingo-sonogram for investigation of infertility. Her infection was resistant to antibiotic treatment and she required extensive surgical intervention for source control, which impacted her fertility. The immunodeficient pelvic microenvironment in patients with endometriosis and endometrioma can increase the risk and severity of pelvic infection. Antibiotic prophylaxis should always be utilized in patients with stage IV endometriosis who are due to undergo saline infusion sonohysterography or hysterosalpingo-sonography. • Saline ultrasound can result in pelvic infection in select patient populations. • Stage IV endometriosis has a higher infection risk due to an altered pelvic environment. • Antibiotics before saline ultrasound are necessary for stage IV endometriosis. • With deep pelvic infection and endometriosis, surgery is more likely to be required. • The necessity of saline US in deep endometriosis warrants careful consideration.

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Condition tags

endometriosisdie_deep_infiltratingendometriomainfertility

Citation neighborhood

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.

References (21)

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