Pelvic abscess following microwave endometrial ablation

Abstract

A 44 year old woman presented with severe left-sided lower abdominal pain three days after a microwave endometrial ablation for menorrhagia. The pain was described as sharp, worsened with movement and associated with vomiting. She had not opened bowels since the operation. It was severe enough to require opiate analgesia. She had undergone a microwave endometrial ablation procedure three years previously for treatment of menorrhagia. However, over the last eight months, the symptoms had returned and she requested a second microwave endometrial ablation. She had a twin pregnancy following IVF treatment 11 years ago. The twins had been delivered by caesarean section. She was also known to have pelvic endometriosis.The microwave endometrial ablation procedure was preceded by saline hysteroscopy that revealed a normal size, anteverted uterus with a regular endometrial cavity. The saline was then aspirated from the endometrial cavity. An uneventful microwave endometrial ablation was then performed. The treatment lasted 2 1 = 2 minutes and the entire cavity was ablated.On admission, the patient was febrile and tachycardic. Abdominal examination revealed tenderness over the left iliac fossa but was not associated with guarding or rebound. Bowel sounds were present and normal.A full blood count revealed an elevated white cell count of 15.1 Â 10 9 /L with a predominance of neutrophils, C-reactive protein was raised at 374 mg/L (normal <5 mg/L). Abdominal and chest X-ray did not show any evidence of bowel perforation. A working diagnosis of endometritis was made, and a broad-spectrum antibiotic commenced. Her symptoms initially settled with this treatment. Transabdominal ultrasound scan showed a 6-cm mass of mixed heterogeneity in the left iliac fossa. CA125 was found to be mildly elevated at 44 IU/L (normal <25 IU/L).In view of these findings, laparotomy was performed via a midline incision. On the left side, a pelvic abscess of approximate size 7 Â 10 cm was identified. The abscess extended up the left pelvic side wall beneath the sigmoid mesentery and inferiorly to the uterus. Although the sigmoid colon itself was inflamed, the serosa was intact with no evidence of thermal injury. The uterine serosa showed signs of inflammation without any evidence of thermal injury or perforation. The left tube and ovary could not be visualised. The right ovary had an endometrioma of approximately 4 cm, and was adherent to the pelvic wall on that side. The Pouch of Douglas was obliterated by adhesions.Following surgical drainage, treatment with intravenous metronidazole, 500 mg 8 hourly, and ciprofloxacin, 500 mg 8 hourly, was followed by oral antibiotics for two weeks. Microbiological culture from the abscess revealed growth of lactose fermenting coliforms and mixed anaerobes and confirmed sensitivity to the prescribed antibiotics. The patient made a good recovery and was discharged home on the seventh post-operative day.The woman was readmitted 10 days later with a recurrence of symptoms. Full blood count continued to show raised wh...

The effectiveness of microwave endometrial ablation combined with hysteroscopic transcervical resection in treating submucous uterine myomas: A retrospective study

“…It is important to consider the safety of MEA, as complications include heat injury to the pelvic organs, uid retention in the uterus (because of cervical stenosis or the ablated endometrium), hematometra, pelvic in ammation (e.g., endometritis because of ascending infection), and pyometra. 9 However, we did not detect any of these complications, which may be related to the use of a resectoscope to evaluate the endometrial lining immediately after MEA. This step allowed for the maximum removal of the necrotic tissue left over by ablation, and we believe that it can improve the safety of MEA by reducing the rate of complications.…”

Appendicitis and uterine abscess: presentation of an unusual fistula between the gynaecological and gastrointestinal tracts

“…Abscesses have been reported after treatment with endometrial ablation however, these have only been reported as presenting within the first few weeks after surgery 7–9. There is a risk of full thickness uterine damage after endometrial ablation and this may represent another mechanism for the association of appendicitis and uterine abscess in this case as there is the possibility the appendix adhered to the uterus at the time of the ablation procedure.…”

Bilateral hydrosalpinges masquerading as ovarian cancer: a late complication of microwave endometrial ablation: a case report and literature review

“…For the time period January 2003 to December 2006, no hydro or haematosalpinges were reported. There is a solitary report of a pelvic abscess following MEA reported in the literature [17].…”