Strategic management of post hysteroscopy pelvic abscess

This case report details the presentation, diagnosis, and management of a 32-year-old nulligravida who presented with lower abdominal pain, fever, and vomiting for 2 days. The patient had a history of pre- in vitro fertilization hysteroscopy 1 week back and laparoscopic ovarian cystectomy and ovum pickup in the past 5 months. Initial examination revealed severe tenderness in the left iliac region and an ill-defined mass in the left adnexa. Ultrasound and magnetic resonance imaging confirmed left ovarian endometriotic cysts with bilateral kissing ovaries. Conservative management with antibiotics and symptomatic treatment stabilized the patient, but subsequent laparoscopy revealed extensive bowel and omental adhesions, resulting in a frozen pelvis. Adhesiolysis and drainage of a pus-filled abscess were performed. Postoperatively, the patient recovered well and was discharged on the third postoperative day. Follow-up transvaginal ultrasound after 1 month showed no evidence of pelvic collection. This case underscores the importance of considering potential complications following hysteroscopy, especially in patients with a history of pelvic surgeries, and highlights the successful management of a complex clinical scenario involving pelvic abscess and frozen pelvis.