Abstract
BackgroundDuring pregnancy, the discovery of adnexal masses remains frequent. Such masses are mostly benign. Ovarian endometrioma is a rare etiology. The diagnosis may be difficult in some situations, such as decidualization. It may be asymptomatic or result in complications for which magnetic resonance imaging is needed.Case presentationWe describe an unusual case of decidualization of an ovarian endometrioma complicated by a sigmoid fistula during a 7-week, 1-day pregnancy in a Arabic patient aged 38 years who developed acute pelvic pain with fever. She had a medical history of unexplored secondary dysmenorrhea. The diagnosis was suspected on the basis of magnetic resonance imaging findings. The management was based on surgery, during which exploration revealed a mass at the expense of the left ovary being very adherent and fistulized to the sigmoid. We performed adnexectomy followed by digestive ostomy. The result of pathological study with immunohistochemistry led to a diagnosis of decidualization of an ovarian endometrioma altered by infection.ConclusionDecidualization of an ovarian endometrioma can lead sometimes to unexpected complications. The decision to provide surgery must be made with caution without delaying treatment in the event of a deep suspicion of malignancy and/or complication. The particular and exceptional complication discovered in our patient is the fistulization to the sigmoid.
Highlights
Access to ultrasound at the beginning of pregnancy makes the association between pregnancy and adnexal mass an increasingly frequent situation [1]
Due to the persistence of the symptomatology and the increase of C-reactive protein (CRP) (294 mg/l vs 254 mg/l) after 1 week of treatment, an ultrasound control was performed, which objectified a progressive intrauterine pregnancy with persistence on the left side, of the two cysts that appeared as heterogeneous echogenic images with a thickened wall in places, pseudovegetations not taking the Doppler, and the presence of a liquid and thin effusion in the cul de sac of the pouch of Douglas (Fig. 1)
Ectopic deciduosis can be revealed by a noisy symptomatology related to a complication
Summary
A decidualized ovarian endometrioma can lead sometimes to unexpected complications. The decision to perform surgery must be made with caution without delaying treatment in the event of a strong suspicion of malignancy and/or a complication. The particular and exceptional complication discovered in our patient is the fistulization to the sigmoid, which explains the persistence of the clinical symptomatology. The infection was probably a cause of the ultrasound and MRI changes. Histology was key to the diagnosis despite changes due to the infection
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