Laparotomic hemostatic surgery for ovarian rupture complicated with severe ovarian hyperstimulation syndrome: a case report

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  • YOON Soonna
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • FUKUDA Aya
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • FUKUOKA Hiroko
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • TSUBOUCHI Hiroaki
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • OHYAGI Chifumi
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • WADA Azusa
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • UMEZAWA Naho
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital
  • TSUTSUI Tateki
    Department of Obstetrics and Gynecology, Japan Community Healthcare Organization Osaka Hospital

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Other Title
  • 重症卵巣過剰刺激症候群に卵巣破裂を合併し開腹止血術を要した1例
  • 症例報告 重症卵巣過剰刺激症候群に卵巣破裂を合併し開腹止血術を要した1例
  • ショウレイ ホウコク ジュウショウ ランソウ カジョウ シゲキ ショウコウグン ニ ランソウ ハレツ オ ガッペイ シ カイフク シケツジュツ オ ヨウシタ 1レイ

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Abstract

<p>Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic disease associated with excessive ovarian stimulation, and is potentially life-threatening complication in severe cases. Ovarian rupture associated with OHSS is rare, and the incidence is reported to be 0.1% after IVF (in vitro fertilization) treatment. Here we present a case of ovarian rupture necessitating a laparotomic surgery after hCG administration in controlled ovarian hyperstimulation procedure. A 34-year-old infertile woman was treated with controlled ovarian hyperstimulation with GnRH agonist long protocol at a private clinic. Intracytoplasmic sperm injection (ICSI) was performed, but embryo transfer could not be carried out due to failure of embryonic cell division. She was referred to our hospital seven days after hCG injection with multiple symptoms including severe abdominal pain, nausea, vomiting, and abdominal distention. An ultrasonograpy showed bilateral enlarged ovaries (right ovary 9.5 cm, left ovary 11.6 cm) with multiple cyst and significantly increased peritoneal fluids. She was admitted to our hospital with the diagnosis of severe OHSS. Her abdominal pain and dyspnea became worse and anemia deteriorated. Sonographically guided ascites aspiration revealed bloody fluid collection in her abdomen, and her hemoglobin dropped from 9.2 to 6.1 g/dl. Active bleeding from her ruptured ovary was suspected in contrast-enhanced abdominal CT. Emergency laparotomy showed that both ovaries were enlarged about 15 to 20 cm with multiple cysts after aspiration of 1500 ml of hemoperitoneum. Bleeding from the ruptured lesion of the left ovary was observed. It was difficult to suture because the surface of her ovary was very vulnerable, so TachoSil® fibrin sealant patches were placed on the bleeding lesions of left ovary. She was kept in the intensive care unit for four days until pulmonary edema and oliguria improved, and was discharged from the hospital 11 days after surgery. We reported a case of a ovarian rupture case necessitating an emergency laparotomic surgery complicated in severe OHSS. Ovarian rupture associated with OHSS is difficult to diagnose because of the relative paucity of cases. It is important to keep in mind the possibility of ovarian rupture if patient with OHSS complains of severe abdominal pain. [Adv Obstet Gynecol, 69 (2) : 100-106, 2017 (H29.5) ]</p>

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