Severe pelvic adhesions following attempted ultrasound-guided drainage of bilateral ovarian endometriomas

A 38 year old woman was thought to have bilateral polycystic ovaries and an absence of pelvic or abdominal adhesions at diagnostic laparoscopy. Post-operative transvaginal ultrasound noted bilateral homogeneous hypoechoic masses with low-level echoes consistent with endometriomas. Transvaginal aspiration was unsuccessful due to the viscosity of the cyst contents. At second laparoscopy severe adhesions with complete cul-de-sac obliteration were noted. This case raises concern about pelvic adhesions following transvaginal drainage of ovarian endometriomas.