Laparo-endoscopic Approach for Large Ovarian Cyst in the Morbidly Obese: Case Report

We report a successful case of laparo-endoscopic single site total hysterectomy and bilateral salpingo-oophorectomy (LESS THBSO) using conventional laparoscopic instruments for a large ovarian cyst in a morbidly obese woman. A 58-year-old female with a BMI of 46kg/m2 complaint of abdominal distension. A pelvic ultrasound revealed a left ovarian cyst measuring 21.3 x 15.2 x 20.8 cm. The IOTA score is 3.5% and the RMI score was 51, suggesting a benign pathology. LESS THBSO was performed and the final histology was a benign ovarian mucinous cystadenoma. The patient recovered well with no postoperative complications. This case demonstrates that LESS is feasible for large ovarian cysts even in morbidly obese patients when appropriate cases are selected and when the patient is managed in a multi-disciplinary team.

Ovarian Cysts Management Following Laparoscopic Surgery

Objective: To analyze diagnostic and surgical outcomes in patients with extremely large ovarian cysts treated by laparoscopic surgery. Methods: A total of 120 cases of large adnexal masses and suspected for malignancy were treated laparoscopically at the at general surgery department of Liaquat University of Medical & Health Sciences. Under endotracheal anesthesia, all surgeries were performed using nasogastric tubes in the stomach. An incision of approximately 1.5 centimeter was made at the supraumbilical or umbilical region and peritoneal cavity was approached. The intra-abdominal approach in all cases was cautiously standardized. The resection of the adnexal mass was performed as per routine method. Results: 12 females were premenopausal and 8 were postmenopausal. 12 women presented with the signs of urinary retention, urinary urgency and abdominal pain. Incidental sonography detected cysts in 8 patients which were asymptomatic. The average volume of the resected cystic fluid was 3000ml (range 900 to 9000 ml). The specimens of frozen section were obtained within the surgical procedure in all patients except 2 patients having para-ovarian cysts. The histopathology presented mucinous benign cystadenoma. There was no blood loss and related other complications reported in all operations. Conclusion: Laparoscopic management of large ovarian cyst observed to a effective, feasible and less complicated surgical option. However accurate selection and diagnosis of the patients, the any ovarian cyst size can be treated easily via laparoscopic surgery.

Ovarian cyst mimicking acute appendicitis in pregnancy: A case report

Ovarian cysts, also known as ovarian masses or adnexal masses are fluid filled sacs or pockets in an ovary or on its surface. These are found incidentally in asymptomatic women. Ovarian cysts are considered large in size when they are over 5 cm and giant when they are over 15 cm. Acute appendicitis is the most common surgical problem encountered during pregnancy. Pregnancy is associated with various anatomic and physiologic changes that may disguise and delay the diagnosis of acute appendicitis. Antibiotic treatment does not always improve the outcome and emergency intervention is required. Early diagnosis and surgical intervention is mandatory for the eventful outcome of pregnancy. Here we present a case of a primigravida patient with a large ovarian cyst mimicking acute appendicitis.

Antenatal laparoscopic management of ovarian cyst: a case report

The frequency of adnexal mass in pregnancy ranges from 2% to 10%, dermoid cyst is the most common ovarian germ cell tumor during pregnancy which could be asymptomatic or symptomatic, management through laparoscopy must be considered as it provides several advantages, including reduced postoperative pain, analgesic use, hospitalization time and better cosmetic result. Here we are reporting a case of an unbooked 35 years old primigravida at 16 weeks and 4 days gestation with history of retention of urine. Ultrasound showed a live foetus of 16 weeks gestation with bilateral mild maternal hydroureteronephrosis and complex cystic mass of 13×10 cm in right lumbar region suggestive of ovarian mass. Patient was clinically stable, hence exploratory laparoscopy was taken up the next day. Intraoperatively, dermoid cyst was found in the right ovary. Right ovarian cystectomy was performed. She had an uneventful postoperative period and discharged. She was monitored for the rest of the pregnancy and it was uneventful. She had spontaneous full term normal vaginal delivery of female baby weighing 2.8 kg. Although the patient was clinically stable, large ovarian cyst are predisposed for future complications, hence antenatal diagnosis and appropriate intervention is crucial for good outcome.

Rare case of torsion of giant ovarian mass post-colonoscopy

ABSTRACT We present an unprecedented case of torsion of a large ovarian cyst following colonoscopy. A 43-year-old female was found to have a 20 × 13 × 19 cm pelviabdominal mass possibly arising from the right ovary. Endoscopic evaluation was performed prior to planned resection of the ovarian mass. The patient experienced progressive lower abdominal pain after the procedure with a computed topography finding of torsion. She underwent exploratory laparotomy, right salpingo-oophorectomy with intra-operative frozen section and omentectomy. Final histology revealed features of benign serous cystadenoma with extensive haemorrhagic infarction in keeping with torsion. To our knowledge, this is the first reported case of torsion of a large ovarian cyst after colonoscopy. We propose a postulated mechanism of this patient’s ovarian torsion and urge clinicians to be cognizant of acute ovarian torsion as a cause of severe abdominal pain following endoscopy.

Laproscopic Management of Large Ovarian Cyst with Pregnancy: A Case Report

Background: Before a pregnant woman's baby birth, the incidence of cyst is the most common. Due to availability of quality antenatal ultrasound, ovarian cysts in the pregnant woman are diagnosed more frequently. The large (>5 cm) and complex cysts are symptomatic and it required to be managed by surgical intervention. Cyst might rupture, twist, or even cause problems during childbirth. Aims and objective: To bring relief to a primigravida with 16 weeks pregnancy after spontaneous conception, presented with complain of hugely distended abdomen with marked discomfort and to preserve her pregnancy. Case Report: Materials and Methods: A 26 year old pregnant woman with ovarian cyst was enrolled and treated through laparoscopic management. Results: After the laparoscopic removal of cyst the post-operative period of the pregnant woman was found uneventful. The pregnancy of the woman was progressed smoothly and there was no any complications during the pregnancy. Full term normal delivery (FTNVD) was occurred and the baby was healthy with weight of approximately 2.55 Kgs. Conclusion: Large ovarian cyst can be managed without disturbing the pregnancy and a complicated case can be transformed into a normal ante natal check-ups (ANC).

Ultrasound features of immature ovarian teratomas: Case series and review of literature

Introduction Immature ovarian teratomas are rare but account for 10–20% of ovarian cancers in women under the age of 20 years. This study aimed to characterise immature ovarian teratomas using grey-scale and Doppler ultrasonography and review the literature to refine the diagnosis of immature ovarian teratomas. Methods Patients with a confirmed histological diagnosis of immature ovarian teratoma from years 2006–2018, who had undergone a transvaginal ultrasound at two large teaching hospitals, were identified. The imaging was retrieved from the centres clinical databases. Ultrasound scans were performed by experienced ultrasound examiners and described according to International Ovarian Tumour Analysis criteria. Results Eight patients were identified in total with a mean age of 26 years (range 13–35). Half of the patients had a past history of a mature ovarian teratoma (3 ipsilateral, 1 contralateral). The cysts were generally large (median 115 mm), fast growing unilateral lesions with a single, peripheral predominantly solid component arising from the cyst wall. The solid component was hyperechoic with multiple foci of fibrosis and numerous small cysts. The cystic component typically formed less than 75% of the lesion and the cyst fluid was of low-level echogenicity. Subjective assessment of vascularity of the solid part of the tumours varied between scores of 1 and 2. Tumour markers showed a raised serum a-fetoprotein level in 42% of these patients. Conclusion Although there were no ultrasound features that were pathognomonic of immature teratoma, the diagnosis should be suspected in a young woman with a large ovarian cyst with a fibrotic, microcystic solid component, particularly if she has a past history of a dermoid cyst.