The Hidden Danger in Endometriosis: Bilateral Pelvic Abscesses Following Fertility Treatment

TL;DR

A rare case of bilateral pelvic abscesses after fertility treatment in a woman with endometriosis highlights the importance of advanced imaging for accurate diagnosis.

Contribution

Demonstrates the diagnostic value of multimodal imaging in identifying infectious complications following ART in endometriosis patients.

Findings

Bilateral tubo-ovarian abscesses were diagnosed using a combination of ultrasound, CT, and MRI.

Early imaging helped distinguish infection from endometriosis flare-up, preventing sepsis and preserving fertility.

Abstract

This case report underscores the crucial role of imaging and radiology in the timely diagnosis of a rare but serious complication associated with assisted reproductive technology (ART). A 34-year-old woman with a long-standing history of endometriosis and secondary infertility developed bilateral tubo-ovarian abscesses (TOAs) following in vitro fertilization (IVF). Her presentation included nonspecific gastrointestinal and pelvic symptoms that delayed diagnosis. However, a multimodal imaging approach, combining transvaginal ultrasound, contrast-enhanced computed tomography (CT), and pelvic magnetic resonance imaging (MRI), proved critical in identifying a superimposed infection on chronic adnexal disease. Subsequent surgical exploration confirmed the diagnosis of TOA and hematopyosalpinx. This case illustrates the diagnostic complexity of differentiating infectious processes from endometriotic flare-ups in the post-ART setting and highlights the indispensable role of early and advanced imaging in guiding clinical management, preventing sepsis, and preserving fertility.

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