Publication:

Ethanol sclerotherapy twice and one laparoscopic surgery for stage IV pelvic endometriosis and bilateral ovarian endometrioma over two decades: a case report

In January 2008, Mrs. BP, at the age of 28 years, a para one, live child one, previous lower segment caesarean section (LSCS), and an ovarian cyst, left endometrioma, underwent laparotomy and ovarian cystectomy under spinal anaesthesia. On 12 July 2008, a scan revealed well defined cystic lesions in the right adnexa, 5.0×4.8 cm, and 2.3×2.1 cm and left ovary two cysts measuring 1.8×1.2, and 2.6×1.6 cm. In December 2008, operative laparoscopy was performed. Adhesiolysis, fulguration with dessication of all the visible endometriotic lesions, right ovarian chocolate cystectomy, 10×8 cm. was done. Left ovary had a 1.5 cm endometriotic cyst, that was drained and cyst wall cauterized. Pouch of Douglas, the bowel was pulled up. Methylene blue chromotubation for the patency of the fallopian tubes was positive on both the sides. Diagnosis, stage IV endometriosis. She was treated with ovulogens for two or three cycles. This resulted in ovarian cyst formation, hence stopped. On 17 April 2010, ultrasonography (USG) evidence of a large recurrent right ovarian endometrioma of 10×9 cm one and a half years after the laparoscopic management of stage IV endometriosis in 2008. The first ethanol sclerotherapy (EST) was done in this case on 27 November 2010, under USG guidance. She conceived spontaneously in 2018. Second delivery by LSCS in USA, a boy 4.125 kg on 05 December 2018. Left ovarian chocolate cyst noted in February 2020, EST was done a second time. Aspirated 120 ml of chocolate thick material. On 24 February 2020, injected 7 ml of absolute alcohol into the left ovarian chocolate cyst under ultrasound guidance. She had a second child, she could avoid a repeat major surgery, both the objectives could be achieved and were facilitated by EST done on two occasions. EST serves to ameliorate endometriosis and serves as an additional modality of treatment in select cases.