A Rare Late Complication of Oocyte Retrieval : Tubaovarian Abscess

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Presentation transcript:

A Rare Late Complication of Oocyte Retrieval : Tubaovarian Abscess Esra Can, Seher Özlem Yılmaz, Merve Talmaç, Gonca Yetkin Yıldırım Istanbul Kanuni Sultan Suleyman Research and Education Hospital Gynecology and Obstetrics Clinic

31 years old 6 year primary infertility ,PCOS Severe left groin pain

PATIENT HISTORY 5 CC and 3 rFSH OI > unsuccesful ovulation 25 oocyte with COH, 6 embryo > embryo freezing 1 month later after OPU > H/S septum resection 2 ET after 4 months of OPU > unsuccesfull pregnancy 2 months OCP use USG at 6.month of OPU > left ovarian size 100x90 mm, multiple hemorrhagic cysts(largest one 54*41 mm) in parenchyma, normal physiologic ovarian blood flow

9 months after OPU> left groin pain and adnexial mass PATIENT HISTORY 9 months after OPU> left groin pain and adnexial mass USG : 9X10 cm left adnexial mass with solid areas and thick septations .

MR A wall thickening in the sigmoid colon proximal segment, edema Cystic component lesion with common septations 110x95x85 mm in the left adnexial area. Due to severe edema and inflammation, tubal chronic abscess formation or a pathological process involving ileal region were considered.

Figure a-b) Cystic component lesion with common septations (arrows)

Collum movement painful 10 cm palpable mass on left adnexial area. PHYSICAL EXAM Menstrual bleeding Collum movement painful 10 cm palpable mass on left adnexial area.

LABORATORY HB:9,7 HTC:33 PLT:424000 WBC:12500 CRP:97,7 PROKALCITONIN:0,039 KOAG.: NORMAL BHCG:0,3 TM MARKERS : NORMAL

ONCOLOGICAL CONSULTATION USG: Suspicious for enfection of the enlarged follicles Malignancy was not considered. Antibiotherapy recommedation

GENERAL SURGERY CONSULTATION 15 kg loss in 4 months >intestinal pathology ? Colonoscopy > Biopsy from a suspected area in sigmoid colon Biopsy > inflammation

FOLLOW UP . Ceftriaxon 1 gr 2x1 iv Metronidazol 500 mg 4x1 iv 14 days . When the patient had not responded to antibiotics, we decided to operate due to the diagnosis of tuba ovarian abscess .

OPERATION At the inspection, the left adnexial mass which was adhered to the sigmoid colon and distal ileum was diagnosed as tubaovarian abscess. Left salpingo-oophorectomy Intestinal segmental resection End-to-end anastomosis

POSTOP FOLLOW UP PO 3. day >TPN PO 4. day> removal of NGS Diet: Regimen 1 PO antibiotics continued PO 6. day> removal of drains and CVP catheter PO 11 . day > purulent discharge from op. incision > wound culture Ciprofloxacin 500 mg tb 2x1

POSTOP FOLLOW UP Daily wound dressing and debridmann Secondary suturation of the open wound on 17. day . Discharge with oral ciprofloxacin for 1 week on 18. day of operation

Tubooavarian Abscess Incidence 1-3 % Infectious pathogenesis primarily due to inoculation of vaginal microorganisms (2) reactivation of latent pelvic infection (hydrosalpinx) (3) direct bowel injury. Limited data on antibiotic use prior to TVOR and ET.