ABSTRACT
Background: Endometriosis is defined as a chronic, inflammatory, estrogen-dependent gynaecologic disease. It affects approximately 5-10% of reproductive-age women worldwide. Ovarian endometriosis is the most frequent form of this condition. Endometriotic cysts are found in about 17-44% of women diagnosed with endometriosis. It is well known, that ovarian endometriomas can cause infertility and chronic pelvic pain. Enlarging cysts can also cause ovarian torsion. In addition, ovarian endometriosis slightly increases the risk for ovarian cancer. The rupture of endometriotic ovarian cysts is an exceptional complication. According to the literature, the prevalence is less than 3% among women with endometriosis. The rupture of an ovarian endometrioma can cause acute peritonitis, which can lead to sepsis, septic shock and can be lethal. The occurrence of abscesses within an ovarian endometrioma is an extremely rare complication. Generally, the origin of infected endometriotic ovarian cysts is related to the previous invasive procedures involving pelvic organs or the use of intrauterine devices. Also, ovarian abscesses can be caused by the hematogenous or lymphatic spread of bacteria. Although, the literature points out that infection of endometriotic ovarian cysts can develop spontaneously. In these rare cases, reservoir and route of infection remains an enigma. Case report: A 49-year-old female was brought to the emergency room with severe generalized lower abdominal pain (6/10) and three days lasting fever. Abdominal examination revealed diffuse abdominal pain with anterior abdominal wall muscle tension. Painful solid masses were felt on both sides of the uterus during the pelvic examination. Cystic masses were detected in both ovaries during transvaginal sonography. Computer tomography (CT) of the abdomen and pelvis revealed abnormal changes in both ovaries. A small amount of free fluid was found in the pelvic cavity along with thickened pelvic peritoneum. Suspecting acute peritonitis and bilateral tubo-ovarian abscesses, surgical treatment was performed. Lower midline laparotomy with bilateral adnexectomy and abdominal lavage with 4000 ml normal saline were done. The outcome of peritonitis was evaluated using the Mannheim peritonitis index (MPI=17 - low risk of morbidity and mortality). The histopathological examination revealed the diagnosis of bilateral endometriotic cysts complicated with acute inflammation, with associated acute inflammation of both fallopian tubes. Microbiological cultures from the purulent fluid were negative. Conclusions: Although the occurrence of abscesses within an ovarian endometrioma is an extremely rare finding in clinical practice, it has to be considered by gynaecologists because it might result in a surgical emergency that can be life-threatening. Being aware of the risk factors of abscesses within an endometrioma can lead to an early diagnosis of this rare condition and help to avoid serious complications.
ABSTRACT
Endometrioma superinfection is uncommon and poorly described in the literature. This rarity has precluded agreement on optimal management, with most authors treating these lesions as endometriomas rather than abscesses and thus recommending laparoscopic or open cystectomy or oophorectomy. We present a minimally-invasive alternative, illustrated in the case of an infected endometrioma which was successfully managed via image-guided percutaneous drainage.
Subject(s)
Bacterial Infections/surgery , Drainage/methods , Endometriosis/microbiology , Adult , Female , Firmicutes/isolation & purification , HumansABSTRACT
RESUMEN OBJETIVO: reportar un caso de endometrioma complicado con absceso ovárico, exponer y discutir los factores de riesgo asociados, con la finalidad de difundir esta rara alteración y establecer el diagnóstico oportuno. CASO CLÍNICO: paciente de 34 años de edad, que acudió a consulta al Hospital Santa Rosa de Lima (Ensenada, Baja California Norte), con antecedente de dolor pélvico crónico de 5 meses de evolución y fiebre intermitente. El tratamiento con antibiótico de amplio espectro no mostró reacción satisfactoria. El ultrasonido transvaginal del ovario derecho mostró una imagen compatible con endometrioma. Mediante laparotomía se disecó la cápsula y se drenaron múltiples adherencias tubo-ováricas. El informe histopatológico confirmó el diagnóstico de endometrioma complicado por absceso. CONCLUSIÓN: es importante conocer los factores de riesgo para definir la causa de un absceso en un endometrioma, a través de la historia clínica detallada. La sospecha y diagnóstico oportuno es trascendental para reducir la morbilidad y mortalidad de esta complicación. Cualquier mujer con endometriosis en etapa avanzada es susceptible de complicaciones, como la formación de un absceso ovárico espontáneo.
ABSTRACT OBJETIVE: To report a case of Endometrioma complicated with ovarian abscess, expose and discuss the factors of risk associated with the purpose of disseminating this rare alteration and establishing the appropriate diagnosis. CASE REPORT: A 34 year old, seen at the Santa Rosa de Lima Hospital in Ensenada, Baja California, for a history of 5 months long chronic pelvic pain with intermittent fever, under treatment with broad spectrum antibiotic with no improvement. Transvaginal ultrasound revealed a compatible image with an endometrioma on the right ovary, followed by a laparotomy, capsule dissection and release of multiple tube-ovarian adhesions. The histo-pathological report confirmed that it was an ovarian endometrioma complicated by abscess. CONCLUSION: We emphasized in the study the risk factors and define a cause of an endometrioma and the clinical history details. Prevention and a good diagnoses as a priority to reduce morbi-mortality. It is very important to know that any woman with advanced stage history of endometriosis is susceptible to complications.
