Ascites Due to Ovarian Hyperstimulation in the Setting of Covert Ovum Extraction: A Diagnostic Challenge

Introduction Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation in assisted reproductive technologies, characterized by an exaggerated ovarian response leading to increased vascular permeability, fluid accumulation, and potential severe outcomes such as ascites, thrombosis, and peritonitis. Diagnosing OHSS-related ascites can be challenging, particularly in the medicine wards when patients conceal reproductive interventions. Case Summary A 24-year-old female presented with progressive abdominal distention and shortness of breath. Initial examination revealed abdominal distention, bilateral pleural effusions, and a transudative ascitic fluid with normal cytology. Ultrasonography (USG) indicated moderate ascites and bilateral enlarged ovaries. Despite denying prior interventions, the patient was later admitted to egg donation. Treatment with intravenous (IV) fluids, antibiotics, and albumin initially improved her condition. However, she developed peritonitis, indicated by gross pus in a repeat ascitic tap and a positive Escherichia coli culture. Following intensive treatment and peritoneal drainage, the patient improved and was discharged. Discussion Ascites in OHSS, particularly with covert ovum extraction, can be misleading, complicating diagnosis and management. Progression to peritonitis, characterized by severe abdominal pain and systemic inflammation, can be insidious and challenging to detect without thorough examination. Effective management involves addressing fluid balance, preventing complications such as thrombosis and infection, and ensuring prompt intervention to avoid severe outcomes. Conclusion OHSS-related ascites presents a diagnostic challenge, especially when linked to covert reproductive procedures. Peritonitis can complicate OHSS and necessitate vigilant monitoring and management. A detailed patient history and thorough clinical evaluation are crucial for accurate diagnosis and effective treatment, emphasizing the need for awareness among healthcare providers.