Abstract
Study ObjectiveTo determine the success rate of the “intended conservative management strategy” of ruptured ovarian cysts with hemoperitoneum and the risk factors for surgical interventions in healthy women of reproductive age.MethodsPatients who visited the emergency department with abdominal pain and were diagnosed with a ruptured ovarian cyst with hemoperitoneum between August 2008 and June 2013 were included in this retrospective study. The diagnosis of the ruptured ovarian cysts and hemoperitoneum was based on the clinical symptoms, physical examination and ultrasound and CT imaging. The rate of surgical interventions and the risk factors for surgical intervention were determined.ResultsA total of 78 women were diagnosed with a ruptured ovarian cyst with hemoperitoneum. Most patients (80.8%, 63/78) were managed conservatively, and 19.2% of the patients (15/78) required a surgical intervention. In the multiple logistic regression analysis, the diastolic blood pressure (dBP) (odds ratio [OR] of 0.921 with 95% confidence interval [CI] of 0.855–0.993) and the depth of the total pelvic fluid collection in CT (DTFC_CT) (OR 1.599 with 95% CI 1.092–2.343) were the significant determining factors of surgical intervention after adjustment. The rate of surgical intervention was 6.5% vs. 15.8% vs. 77.8% in the patients with neither dBP≤70 mmHg nor DTFC_CT≥5.6 cm, those with only one of those features, and those with both, respectively.ConclusionMost cases of ruptured ovarian cysts with hemoperitoneum can be managed conservatively. A low diastolic blood pressure and a large amount of hemoperitoneum suggest the need for surgical intervention.
Highlights
Functional ovarian cysts are relatively common in women of reproductive age
We evaluated the success rate of the ‘‘intended conservative management strategy’’ of ruptured ovarian cysts with hemoperitoneum and the risk factors for surgical intervention in healthy women of reproductive age
78 women were diagnosed with a ruptured ovarian cyst with hemoperitoneum on CT imaging
Summary
Most functional ovarian cysts do not cause symptoms and resolve in 1 to 2 months with expectant management [1]. Rupture and hemorrhage of an ovarian cyst may be physiologic events and a self-limited process, they may cause significant hemoperitoneum and require surgical intervention [2]. Because of these diverse clinical situations, a standard management protocol for ruptured ovarian cysts with hemoperitoneum is not well established. Ruptured ovarian cysts with hemoperitoneum have been a surgical emergency. Recent advances in imaging studies have enabled clinicians to make accurate early diagnoses and use careful expectant management with proper patient safety, and conservative management strategies have been suggested as alternatives to conventional surgical intervention [5]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have