Transvaginal Aspiration for Management of Huge Ovarian Endometrioma in Pregnancy

Abstract

Study Objective To demonstrate a minimally invasive approach of a huge ovarian cyst during pregnancy. Design A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and post-operative results. Setting The patient underwent transvaginal procedure in the lithotomy position and under intravenous sedation and ventilation by face mask. Patients or Participants A 34-year-old woman, gravida 1 at 12 weeks 5 days’ gestation, presented with huge ovarian cyst. A transvaginal ultrasound demonstrated ovarian cyst measuring 10.4 × 8.2 cm with no evidence of malignancy, no free fluid, and a normal-appearing contralateral ovary. The crown-rump length measured 5.92 cm. On non-enhanced magnetic resonance imaging (MRI), 11 × 7 cm sized cystic lesion with high signal intensity in T1-weighted image (WI) and T1-weighted fat suppressed image, low signal intensity in T2 WI suggesting endometrioma, located in cul-de-sac was noted. Because the cyst was huge and deeply located in cul-de-sac, and the uterus was enlarged to 13 weeks size, approach through laparoscopy or even laparotomy was thought to be difficult and the risk of manipulation for uterus was high. So, we decided to aspirate the ovarian cyst through the vaginal route. Interventions Ultrasound-guided transvaginal aspiration was performed using an 18-G needle. Measurements and Main Results The operation time was 4 hours and 35 minutes with 305 mL dark brownish fluid drained. The patient recovered well and was discharged 2days after the procedure. There was no intraoperative or postoperative complication. Postoperative ultrasound revealed neither recurrence nor fetal abnormality. Until delivery, the patient was free of symptom and ultrasound revealed neither recurrence nor fetal abnormality. Conclusion In select pregnant woman with endometrioma requiringintervention, the risks of surgery may be minimized with aspiration. Transvaginal ultrasound-guided aspiration is a safe, feasible, and effective minimally invasive procedure for huge ovarian endometrioma in pregnancy. To demonstrate a minimally invasive approach of a huge ovarian cyst during pregnancy. A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and post-operative results. The patient underwent transvaginal procedure in the lithotomy position and under intravenous sedation and ventilation by face mask. A 34-year-old woman, gravida 1 at 12 weeks 5 days’ gestation, presented with huge ovarian cyst. A transvaginal ultrasound demonstrated ovarian cyst measuring 10.4 × 8.2 cm with no evidence of malignancy, no free fluid, and a normal-appearing contralateral ovary. The crown-rump length measured 5.92 cm. On non-enhanced magnetic resonance imaging (MRI), 11 × 7 cm sized cystic lesion with high signal intensity in T1-weighted image (WI) and T1-weighted fat suppressed image, low signal intensity in T2 WI suggesting endometrioma, located in cul-de-sac was noted. Because the cyst was huge and deeply located in cul-de-sac, and the uterus was enlarged to 13 weeks size, approach through laparoscopy or even laparotomy was thought to be difficult and the risk of manipulation for uterus was high. So, we decided to aspirate the ovarian cyst through the vaginal route. Ultrasound-guided transvaginal aspiration was performed using an 18-G needle. The operation time was 4 hours and 35 minutes with 305 mL dark brownish fluid drained. The patient recovered well and was discharged 2days after the procedure. There was no intraoperative or postoperative complication. Postoperative ultrasound revealed neither recurrence nor fetal abnormality. Until delivery, the patient was free of symptom and ultrasound revealed neither recurrence nor fetal abnormality. In select pregnant woman with endometrioma requiringintervention, the risks of surgery may be minimized with aspiration. Transvaginal ultrasound-guided aspiration is a safe, feasible, and effective minimally invasive procedure for huge ovarian endometrioma in pregnancy.