case of large bilateral tubo-ovarian masses with pelvic adhesions & severe sepsis managed

in Max Super Speciality Hospital, Saket

Feb 02 , 2023

"A complex and high-risk case of large bilateral tubo-ovarian masses with extensive pelvic adhesions and severe sepsis managed successfully."

A 37-year-old P1L1 female, with a history of endometriosis and pelvic tuberculosis on Anti-Tuberculosis Drugs (ATT) (for eight months), was being treated elsewhere with IV antibiotics for high-grade fever and lower abdominal pain. Since her condition was not improving, she was transferred to Max Super Speciality Hospital, Saket, for further management.

The patient was sick and had severe sepsis. Pre-operative investigations revealed leucocytosis, anaemia and thrombocytosis reference taken from hematologist. Pelvic imaging (ultrasound/MRI) revealed dilated thick-walled fallopian tubes bilaterally with pyosalpinx on the background of Endometriosis forming large tubo-ovarian masses, demonstrating extensive adhesions with each other to the posterolateral uterine wall and the adjacent bowel loops.

After PAC clearance, the patient was taken up for laparoscopic removal of bilateral tubo-ovarian masses. Thick pus was drained from tubo-ovarian masses. Extensive adhesiolysis was done to separate the tubes from the uterus and bowel. The TO masses were taken out through endobag. A small part of the right ovary was preserved.

Cystoscopy and DJ stenting were done by urologist. The post-operative period was uneventful, the patient was stable and asymptomatic on discharge. The patient is scheduled for regular check-ups. This highlights the availability of multiple specialists at Max Hospitals to take care of such high risk cases successfully.