Perforated Viscus as a Rare Complication of Ovarian Hyperstimulation Syndrome: A Case Report

Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of in vitro fertilization (IVF).While abdominal pain and intra-abdominal free fluid are common manifestations of OHSS, intestinal perforation occurring in patients with OHSS is extremely uncommon.We report a case of small bowel perforation following IVF in a patient with features of OHSS, presenting a diagnostic challenge due to overlapping clinical features.A 39-year-old female patient presented with severe lower abdominal pain 5 days after undergoing ovum retrieval for IVF.The patient's past surgical history included sleeve gastrectomy nine years prior and gastric bypass surgery two years earlier, without postoperative complications during the preceding two years.On presentation, she was tachycardic with lower abdominal tenderness and guarding.Laboratory investigations showed leukocytosis and a rising CRP.Bedside ultrasound showed intra-abdominal free fluid.IV contrastenhanced CT raised concerns for gastrointestinal perforation and demonstrated features suggestive of OHSS.The patient rapidly deteriorated.Given the concern for gastrointestinal perforation and evolving septic shock, the patient underwent diagnostic laparoscopy, which was converted to a midline laparotomy.A 1.5-cm perforation at the jejunal omega loop near the gastrojejunal anastomosis was identified and primarily repaired with abdominal washout.During the laparotomy, a bulky uterus and enlarged ovaries with large ovarian cysts were also noted.The postoperative course was complicated by pulmonary embolism and septic shock; however, she improved with appropriate management and was discharged home in good condition.This case emphasizes that although OHSS commonly presents with abdominal pain and ascites following IVF, physicians should consider bowel perforation as a differential diagnosis in patients presenting with severe abdominal pain, particularly in patients with previous bariatric surgery.