Repeated recurrence with antibiotic treatment requiring adnexal resection: a case of ovarian abscess with endometrial cyst after oocyte retrieval

Abstract

　Tubo-ovarian abscess (TOA) is a severe pelvic inflammatory disease and a possible complication of oocyte retrieval in patients with endometrial cysts. A 37-year-old nulligravida with infertility complicated by endometrial cysts had oocyte retrieval performed at a fertility clinic. On Day 9 after retrieval, she developed abdominal distention and fever, and was admitted to an emergency hospital with a diagnosis of ovarian enlargement and peritonitis. Antibiotics (meropenem) were administered, and she was discharged on Day 36 after symptoms improved. Following this, she experienced two flare-ups and was re-admitted to the hospital and treated with the same antibiotic. Despite a total hospital stay of 80 days, no improvement was seen, and she was transferred to our hospital. She was diagnosed with refractory left TOA, and underwent laparoscopic surgery, revealing strong intra-abdominal adhesions. Thereafter, she was shifted to an open laparotomy and underwent a left adnexectomy. In suspected cases of TOA, appropriate treatment should be given at the right time.