Post laparoscopic massive vulvar edema in woman with ovarian hyperstimulation syndrome

Abstract is not required for Clinical Imageis not required for Clinical Image (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 9 No. 1, January 2018. ISSN: 0976-3198 Int J Case Rep Images 2018;9(1):66–68. www.ijcasereportsandimages.com Sopa et al. 66 CASE REPORT OPEN ACCESS Post laparoscopic massive vulvar edema in woman with ovarian hyperstimulation syndrome Negjyp Sopa, Mette Toftager


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range. Vulva was completely normalized after one week ( Figure 2) and an ultrasound scan showed a normal intrauterine singleton pregnancy in gestational week seven.

DISCUSSION
Very few publications on ovarian hyperstimulation syndrome involve development of vulva edema. The first case describing OHSS and vulva edema was published in 1995 [1]. The suggested etiology was oncotic and hydrostatic pressure imbalance. Multiple treatments with local use of cortisone, antibiotic ointments and ice packs were initiated in combination with OHSS therapy. Another publication including nine cases of severe OHSS were paracentesis was indicated found presentation of unilateral vulva edema when the paracentesis was performed in the lower abdomen [2]. The location of the edema corresponded to the puncture side and was developed within less than 24 hours. This may be due to a fistula between the peritoneum and subcutaneous tissue caused by the paracentesis together with the increased intraabdominal pressure due to ascites, which forces the passage of fluid to the labia presenting as edema. Patients in whom were paracentesis was performed in the abdominal hypochondriac regions, and no development of vulva edema were seen. The same process is described in another case [3], and also in cirrhotic men and women suffering from scrotal and vulva edema, respectively, after paracentesis [4,5]. Presentation of bilateral vulvar edema after transvaginal paracentesis has been described [6]. Vulva edema after laparoscopic surgery has been described previously, however, without association to IVF treatment and development of OHSS [7][8][9]. The pathogenesis of post laparoscopic vulvar edema is still unclear. In case, the patient developed OHSS laparoscopic surgery after IVF treatment after which. We believe that the rapid decrease of p-albumin to levels significant below normal range has contributed to the development of the vulva edema, with diminished oncotic pressure. One could further speculate that placement of the laparoscopic ports may have create a fistula where ascites fluid is forced into the interstitial space of the vulva area. The patient was successfully treated with infusion of human albumin.

CONCLUSION
We present a rare manifestation of ovarian hyperstimulation syndrome and massive vulvar edema, after laparoscopic surgery. Infusion of human albumin normalized the vulva completely and gives the impression that hypoalbuminemia is important for the development of vulva edema.

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