Transvaginal drainage of ascites as an alternative to abdominal paracentesis in patients with sever ovarian hyperstimulation syndrome, obesity, and generalized edema

Objective: To describe an alternative technique for transvaginal drainage of ascites in a case of severe ovarian hyperstimulation syndrome (OHSS), generalized edema, and obesity. Design: Case report. Setting: A university-based hospital IVF and Reproductive Medicine Unit. Patient(s): A patient hospitalized with severe OHSS after IVF-ET in whom drainage of large amounts of ascitic fluid was necessary. Intervention(s): Ultrasonographic transvaginal insertion of a wire guide through a standard IVF needle into the Douglas pouch. Placement of a 'peel-away' set on the wire, which was replaced with a 'pigtail' indwelling catheter. Main Outcome Measure(s): amount of drained ascitic fluid. Result(s): Ascitic fluid was drained efficiently, leading to improvement of the patient's condition. Conclusions(s): Transvaginal ultrasonography-guided insertion of a pigtail catheter though the Douglas pouch is an efficacious procedure when the abdominal approach for decompression of ascites is difficult.