Successful laparoscopic resolution of subileus following ethanol sclerotherapy of an ovarian cyst: A case report

Transvaginal ultrasound-guided aspiration and sclerotherapy with ethanol is a conservative means of treating an ovarian endometrial cyst. Its simplicity, minimal invasiveness, and a relatively low recurrence rate make it an attractive option. However, if ethanol should leak into the pelvic cavity, inflammation is incited, and pelvic adhesions may result. Herein, we report a case of successful laparoscopic surgical intervention for a subileus due to past ethanol sclerotherapy. The patient, a 26 year-old single female, underwent ethanol sclerotherapy eight years previously at another hospital for a right ovarian cyst. During the procedure, some leakage of ethanol was evident, and she had since suffered from intestinal problems, such as severe constipation. Sudden onset of severe right lower abdominal pain prompted her visit to our center. Based on our evaluation, a diagnosis of the ruptured right ovarian cyst and subileus was made. Laparoscopic findings documented extensive adhesions of small intestine, sigmoid colon, and omentum with abdominal wall. Rupture of a right ovarian cyst was also confirmed. Past ethanol leakage was the presumed etiology, because (1) the adhesions were mostly limited to pelvic cavity, (2) sclerotic, thickened, fibrous peritoneum and band-like adhesions had formed around the pouch of Douglas, and (3) there was no other likely explanation. Following laparoscopic lysis of adhesions, her intestinal problems resolved and pertinent diagnostic parameters (ie, abdominal x-ray) have subsequently improved. We conclude that if the ethanol sclerotherapy is elected, the possibility of ethanol leakage should be subject to direct scrutiny and precautionary measures should be taken to avoid later complications.