1. 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

2. 31 years old
6 year primary infertility ,PCOS
Severe left groin pain

3. 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

4. 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 .

5. 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.

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

7. 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.

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

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

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

11. 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 .

12. 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

13. 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

14. 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

15. 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.