Ethanol sclerotherapy twice and one laparoscopic surgery for stage IV pelvic endometriosis and bilateral ovarian endometrioma over two decades: a case report

Pratibha Devabhaktuni, Mahjabeen Singh
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · doi:10.18203/2320-1770.ijrcog20261465 · W7160496360
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This case report describes a patient with stage IV endometriosis who avoided repeat major surgery through two ethanol sclerotherapy treatments for recurrent ovarian endometriomas, successfully conceiving and delivering two children.

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This single-patient case report describes a woman with stage IV pelvic endometriosis and bilateral ovarian endometriomas followed over more than two decades, who initially underwent laparotomy and later operative laparoscopy with adhesiolysis and endometriotic lesion ablation plus bilateral endometrioma management, with methylene blue chromotubation showing bilateral tubal patency. After ovarian cyst formation following ovulogens and subsequent recurrence of a large right endometrioma, the patient received ultrasound-guided ethanol sclerotherapy (EST) twice for recurrent ovarian “chocolate” cysts, with 120 mL aspirated before left-sided EST and 7 mL absolute alcohol injected. Spontaneous conception occurred in 2018, resulting in a live birth, and EST was used again in 2020, allowing avoidance of repeat major surgery per the report’s account. The paper’s limitation is that it provides only descriptive outcomes in one case, without a comparator or generalizable efficacy assessment. This paper is centrally about endometriosis — it reports longitudinal management of stage IV pelvic endometriosis and bilateral ovarian endometriomas using ethanol sclerotherapy.

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Abstract

In January 2008, Mrs. BP, at the age of 28 years, a para one, live child one, previous lower segment caesarean section (LSCS), and an ovarian cyst, left endometrioma, underwent laparotomy and ovarian cystectomy under spinal anaesthesia. On 12 July 2008, a scan revealed well defined cystic lesions in the right adnexa, 5.0×4.8 cm, and 2.3×2.1 cm and left ovary two cysts measuring 1.8×1.2, and 2.6×1.6 cm. In December 2008, operative laparoscopy was performed. Adhesiolysis, fulguration with dessication of all the visible endometriotic lesions, right ovarian chocolate cystectomy, 10×8 cm. was done. Left ovary had a 1.5 cm endometriotic cyst, that was drained and cyst wall cauterized. Pouch of Douglas, the bowel was pulled up. Methylene blue chromotubation for the patency of the fallopian tubes was positive on both the sides. Diagnosis, stage IV endometriosis. She was treated with ovulogens for two or three cycles. This resulted in ovarian cyst formation, hence stopped. On 17 April 2010, ultrasonography (USG) evidence of a large recurrent right ovarian endometrioma of 10×9 cm one and a half years after the laparoscopic management of stage IV endometriosis in 2008. The first ethanol sclerotherapy (EST) was done in this case on 27 November 2010, under USG guidance. She conceived spontaneously in 2018. Second delivery by LSCS in USA, a boy 4.125 kg on 05 December 2018. Left ovarian chocolate cyst noted in February 2020, EST was done a second time. Aspirated 120 ml of chocolate thick material. On 24 February 2020, injected 7 ml of absolute alcohol into the left ovarian chocolate cyst under ultrasound guidance. She had a second child, she could avoid a repeat major surgery, both the objectives could be achieved and were facilitated by EST done on two occasions. EST serves to ameliorate endometriosis and serves as an additional modality of treatment in select cases.
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Ethanol sclerotherapy twice and one laparoscopic surgery for stage IV pelvic endometriosis and bilateral ovarian endometrioma over two decades: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20261465Keywords: Endometriosis, Endometrioma, Ethanol sclerotherapy, Endometriotic cystectomy, Secondary infertilityAbstract In January 2008, Mrs. BP, at the age of 28 years, a para one, live child one, previous lower segment caesarean section (LSCS), and an ovarian cyst, left endometrioma, underwent laparotomy and ovarian cystectomy under spinal anaesthesia. On 12 July 2008, a scan revealed well defined cystic lesions in the right adnexa, 5.0×4.8 cm, and 2.3×2.1 cm and left ovary two cysts measuring 1.8×1.2, and 2.6×1.6 cm. In December 2008, operative laparoscopy was performed. Adhesiolysis, fulguration with dessication of all the visible endometriotic lesions, right ovarian chocolate cystectomy, 10×8 cm. was done. Left ovary had a 1.5 cm endometriotic cyst, that was drained and cyst wall cauterized. Pouch of Douglas, the bowel was pulled up. Methylene blue chromotubation for the patency of the fallopian tubes was positive on both the sides. Diagnosis, stage IV endometriosis. She was treated with ovulogens for two or three cycles. This resulted in ovarian cyst formation, hence stopped. On 17 April 2010, ultrasonography (USG) evidence of a large recurrent right ovarian endometrioma of 10×9 cm one and a half years after the laparoscopic management of stage IV endometriosis in 2008. The first ethanol sclerotherapy (EST) was done in this case on 27 November 2010, under USG guidance. She conceived spontaneously in 2018. Second delivery by LSCS in USA, a boy 4.125 kg on 05 December 2018. Left ovarian chocolate cyst noted in February 2020, EST was done a second time. Aspirated 120 ml of chocolate thick material. On 24 February 2020, injected 7 ml of absolute alcohol into the left ovarian chocolate cyst under ultrasound guidance. She had a second child, she could avoid a repeat major surgery, both the objectives could be achieved and were facilitated by EST done on two occasions. EST serves to ameliorate endometriosis and serves as an additional modality of treatment in select cases. Metrics References Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010;27:441-7. DOI: https://doi.org/10.1007/s10815-010-9436-1 Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin N Am. 1997;24:235-58. DOI: https://doi.org/10.1016/S0889-8545(05)70302-8 Exacoustos C, De Felice G, Pizzo A, Morosetti G, Lazzeri L, Centini G, et al. Isolated Ovarian Endometrioma: A History Between Myth and Reality. J Minim Invasive Gynecol. 2018;25(5):884-91. DOI: https://doi.org/10.1016/j.jmig.2017.12.026 Parasar P, Ozcan P, Terry KL. 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