Rupture Of Endometrioma Research Articles

Enhancing endometrioma management: Diagnostic biomarkers and predictive outcomes in Ruptured vs. Non-Ruptured cases

ObjectiveTo compare the outcomes between patients undergoing surgery for ruptured endometrioma versus non-ruptured endometrioma. Study DesignThe study was conducted at Health Sciences University, Etlik Zübeyde Hanım Training and Research Hospital Infertility Clinic. All patients who had a histopathology report of endometrioma between January 2014 and December 2020 were recruited. Patient files, surgery notes and laboratory values were extracted from the electronic recording system and patients with ruptured endometriomas (RE) or non-ruptured endometriomas (NRE) were compared. ResultsOverall, 181 patients were recruited to the study. No rupture was detected in 146 (80.7 %) patients while 35 patients (19.3 %) underwent surgery for RE. Pre-operative CRP, CA 125, CA 19–9, CA 15–3, CEA and mean platelet volume (MPV) values and postoperative MPV and neutrophil/lymphocyte ratio (NLR) values were statistically significantly higher (p < 0.01) in the RE group compared to the NRE group. Post-operative lymphocyte (p = 0.029) and eosinophyl (p = 0.015) values were significantly lower in the RE group compared to the NRE group. Among the preoperative biomarkers that are evaluated for prediction of rupture; MPV, CA 19–9 and CA-15.3 had a high specifity (>75 %) but a rather low sensitivity (<60 %), meanwhile CRP, CA-125 and CEA had high sensitivity but a low specifity. ConclusionRE patients had significantly higher preoperative CRP, CA 125, CA 19–9, CA 15–3, CEA, and MPV values and postoperative MPV and NLR values while postoperative, lymphocyte and eosinophyl values were significantly lower compared with the NRE patients. Prospective studies with larger sample sizes are needed to determine biomarkers and parameters that can be used for non-invasive diagnosis of endometriosis and predict the possibility of endometrioma rupture.

Clinical features of patients with previous spontaneous rupture of ovarian endometrioma operated electively: a case-control study

BackgroundThe aim of the study is to investigate the proportion and clinical features of previous spontaneously ruptured ovarian endometrioma among women who underwent elective surgery for endometrioma.MethodsThis retrospective study was based on a cohort of elective surgeries for endometrioma performed by the same gynecologic team at Peking Union Medical College Hospital from January 2017 to October 2022. Patients diagnosed with previous spontaneously ruptured endometrioma during elective surgery were enrolled in the ruptured group. In the same cohort, patients with unruptured endometrioma treated during the same period were selected as the unruptured group by 1:2 matching according to age. Demographic and clinical information were collected and compared between two groups.ResultsA total of 422 patients in the cohort were diagnosed with endometrioma. There were 38 patients (9.0%) in ruptured group and 76 patients in unruptured group. All enrolled participants were treated by laparoscopic surgery. In ruptured group, 86.8% patients had a history of acute abdominal pain, which was only 13.2% in unruptured group (P < 0.001). Compared to unruptured group, patients diagnosed with ruptured endometrioma had a lower BMI (P = 0.021), larger maximum diameter of endometrioma (P = 0.040), higher proportion of cul-de-sac partial obliteration rather than complete obliteration (P = 0.003).ConclusionsSpontaneous rupture of endometrioma is not rare. The proportion of spontaneous rupture of endometrioma in our study was higher than that reported in the literatures. In women with endometrioma, the onset of acute abdominal pain should be considered a rupture of cyst, especially in patients with big cysts.

Diagnostic imaging of ovarian endometrioma rupture with hemoperitoneum

An endometrioid ovarian cyst (known as endometrioma) is the most common variant of external endometriosis. Clinical symptoms range from asymptomatic to negatively affecting on quality of life and daily activities of a reproductive age woman. Rupture of an endometrioid cyst with hemorrhage into the abdominal cavity occurs in 3% of women with this pathology, which is a rare complication.&#x0D; Ruptured endometrioid cysts may present a diagnostic and surgical challenge: patients may have acute abdominal symptoms and hemodynamic instability, also imaging of a ruptured endometrioid cyst may mimic ovarian malignancy. Therefore, the emergency radiologist needs to know the semiotics of an endometrioid cyst with rupture and hemorrhage into the abdominal cavity.&#x0D; We represent the clinical case of a prime diagnosed large endometrioid cyst in a 32-year-old patient, complicated by hemorrhage in the abdominal cavity. In the emergency department, the patient underwent native computed tomography and ultrasound investigation.&#x0D; Based on the study of Russian and foreign literature, the review was made about main aspects of radiation semiotics of endometrioid cysts with rupture and hemorrhage in the abdominal cavity and about of differential diagnosis of rupture of endometrioid cysts with ruptures of functional cysts and malignant cystic ovarian formations.

Emergent and unusual presentations of endometriosis: pearls and pitfalls.

The purpose of this pictorial essay is to highlight atypical and unusual presentations of endometriosis that can be missed or misinterpreted in the emergency setting. Although endometriosis is a chronic disease, it can present acutely with symptoms and imaging mimicking more common acute gynecologic, gastrointestinal, or urinary conditions as well as neoplasms. Furthermore, patients may present emergently prior to an established diagnosis of endometriosis. Here, we present a range of cases including endometrioma rupture and infection, urinary tract involvement and obstruction, bowel obstruction, appendicitis, gastrointestinal infiltration, abdominal masses, and thoracic involvement. Pelvic ultrasound and MRI are the most valuable imaging modalities in the assessment of endometriosis. CT findings are non-specific, but given the widespread use of CT in emergency settings, it is important to recognize CT findings suggestive of the diagnosis in the right clinical setting.

P-328 Comparison of operated ruptured and non-ruptured endometriomas

Abstract Study question Are there differences between cases of ruptured and non-ruptured endometrioma? Summary answer Laboratory and clinical differences were detected between the patients who had surgery for ruptured endometrioma with the patients who had an unruptured endometrioma. What is known already Today, 20-50% of women with infertility problems have endometriosis. The incidence of endometrioma in patients with endometriosis is between 17-44%. Endometrioma is characterized by the presence of ectopic endometrial tissue in the form of cyst formation in the ovary. No value has yet been found to predict endometrioma rupture. Study design, size, duration Our study was conducted at Republic of Turkey Ministry of Health, Health Science University Etlik Zübeyde Hanım Gynecology Training and Research Hospital Infertility Clinic and all patients who were operated for endometrioma and had a histopathology report confirming the presence of endometrioma between January 2014 and December 2020 were included. It is a retrospective study. Participants/materials, setting, methods In this study, demographic characteristics, intraoperative findings, laboratory values and follow-up recommendations of two groups compared. The patients' age, presence of sexual activity or infertility, gravidity, abortion, accompanying systemic disease, operations, drug use, and symptoms were recorded. Preoperative and postoperative complete blood count, Cancer antigen125 (CA125), Cancer antigen19-9 (CA19-9), Cancer antigen15-3 (CA15-3), Carcinoembryonic antigen (CEA), alpha fetoprotein, anti mullerian hormone, fibrinogen, C-reactive protein (CRP) values of the patients were obtained. Main results and the role of chance The mean age of the patients recruited was 29.31±6.35(min:16-max:48). Endometrioma was intact in 146 (80.7%) of 181 patients, while endometrioma rupture was observed in 35 (19.3%) patients. C-reactive protein(p=.003), CA125(p&amp;lt;.001), CA19-9(p=.016), CA15-3(p=.001), CEA(p=.002) and MPV(mean platalet volume) values in the preoperative period of patients with rupture (p=.001) and postoperative CA125(p=.033), MPV(p=.001) and neutrofil/lymphocyte (NLR)(p=.034) values were found to be significantly higher than patients without rupture. The lymphocyte (p=.029) and eosinophil (p=.015) values in the postoperative period were found to be significantly lower than the patients without rupture. In our study, the rate of rupture in patients with sexual activity (11.9%) was found to be significantly lower than the rate of rupture (30.6%) in patients without sexual activity (p=.002). The rate of rupture in patients with a history of infertility (11.4%) was found to be significantly lower than the rate of rupture in patients without infertility (25.5%) (p=.017). In patients with a history of infertility, the duration of infertility in patients with rupture was found to be significantly lower than in patients without rupture (p=.006). The presence of accompanying pathology in ruptured patients was found to be 30 (52.6%) significantly higher than 5 (4.1%) rupture cases without additional pathology (p&amp;lt;.001). Limitations, reasons for caution The limitations of the study are the retrospective design, the evaluation of only patients who have undergone surgery, and it was performed in a single center. Wider implications of the findings Our study has the largest sample size and includes details not found in other studies in the literature, with a detailed examination of the patients' data. We think that our study will make important contributions to the literature in predicting endometrioma rupture. Trial registration number 2021/76

Very High CA125 due to Non-neoplastic Lesion of Ovary

High CA-125 levels have been strongly associated with ovarian malignancy. But due to nonspecific nature of this tumor marker it has been found to be raised to high levels above 1000u/Ml even in some non neoplastic conditions which have to be kept in mind. A young woman was found to have very high Ca125 levels of 3500u/Ml after rupture of endometrioma. Endometrioma, pelvic inflammatory disease, abdominal tuberculosis are some of the nonneoplastic conditions associated with very high levels of Ca125. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11146 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 52-54

Suitable timing of surgical intervention for ruptured ovarian endometrioma

ObjectivePatients with a rare rupture of endometriomas may require surgery. In this retrospective study, we assessed the outcomes of surgical interventions for ruptured ovarian endometriomas. Materials and methodsForty-three patients who underwent surgical intervention for ruptured ovarian endometriomas were studied. Depending on the latency to surgery and endometrioma recurrence, patients were divided into two groups, and then compared with respect to patient profiles, intraoperative findings, and outcomes. ResultsThirty-one of the 43 patients had a known ovarian endometrioma with an average diameter of 6.04 cm. Seventeen (39.5%) patients had a recurrent ovarian tumor during the postoperative follow up. Patients who underwent surgery within 72 hours or after 72 hours showed no difference in baseline characteristics and most clinical outcomes, except for the choice of surgery (p = 0.003) and future fertility (p = 0.005). ConclusionComprehensive and early surgical intervention after endometrioma rupture can assist in excluding ovarian malignancy and can reduce the effects of cyst fluids, prevent adhesions, and preserve fertility.

Long-term follow-up of patients surgically treated for ruptured ovarian endometriotic cysts

Objective Approximately 4% of women are admitted to hospitals because of ovarian cyst rupture, hemorrhage, or torsion. Endometriotic cyst rupture is a rare surgical emergency associated with severe peritonitis and pelvic adhesion, and we aimed to determine its prognosis and long-term outcome. Materials and Methods We reviewed and analyzed the medical records of 11 patients (mean age, 31.8 ± 7.2 years) with ruptured endometrioma and a history of dysmenorrhea (4.9 ± 2.3 of maximum 10) who were surgically treated, and then regularly followed-up for more than 3 years (range, 35–261 months). Results Previous ultrasound examinations revealed pelvic cysts in seven patients. Three patients had a history of endometrioma surgery. In the emergency room, eight patients complained of uterine motion tenderness. Sonography revealed residual ovarian tumors (size range, 4.2–10.4 cm), with or without fluid accumulation in the cul-de-sac. Surgical enucleation by laparoscopy or laparotomy revealed high revised American Fertility Society endometriosis scores (78 ± 20.1) as well as high adhesion scores (48.7 ± 11.3). In the postoperative period, four patients had recurrent ovarian tumors that were related to elevated serum cancer antigen 125 levels and high postoperative pain scores. In contrast, three patients who became pregnant during the postoperative period had low serum cancer antigen 125 levels and pain scores. Conclusion Endometrioma rupture should be considered in females presenting with sudden lower abdominal pain, associated with a history of dysmenorrhea and preexisting pelvic cysts. Emergency surgical intervention may lead to a better prognosis, particularly in patients without a history of previous endometrioma surgery.

Relation of high CA125 and CA19-9 levels with recent rupture of endometrioma

Most of endometriomas with CA125 level over 1,000 IU/mL have related with rupture. This is important in differential diagnosis from malign ovarian disease. However, the mechanism of elevation of CA125 in patients with endometrioma is not clear. We reviewed elevation of CA125 level over 1,000 IU/mL in endometriomas and attempted to explore possible mechanisms of this elevation together with presentation of our current case. A review of the literature suggests that extremely elevated CA125 level combined with high CA19-9 level may indicate a recent rupture of endometrioma.

Feasibility study of laparoscopic surgery for ovarian endometrioma rupture

Objective: To assess the attributes and feasibility of conservative laparoscopic surgery for patients with ruptured ovarian endometrioma.Design: Retrospective analysis.Setting: University medical center.Patient(s): Eighteen patients undergoing laparoscopic surgery at our institution between January, 2005 and December, 2008 for presumed ovarian endometrioma rupture.Intervention: Laparoscopy.Measurements and Key Findings: Of 792 patients undergoing laparoscopic surgery for ovarian endometrioma, rupture occurred preoperatively in 18 (2.3%), with a median age of 32 years. Eight were right-sided lesions and 10 were left-sided. Five patients were actively menstruating, four were in follicular phase, and six were in luteal phase. Rupture followed GnRH agonist treatment in three instances. Laparoscopic surgery was performed within 24 hours for most, with exception of one patient who received a six-month course of GnRH agonist, postponing surgical intervention. Concurrent cystectomy was elected in 16 patients to preserve fertility. In the other two, treatment was limited to irrigation only (due to severe inflammation), with the option of delayed cystectomy following medical (GnRH agonist) management. Conclusions: Rupture of ovarian endometrioma is an infrequent event, requiring emergency surgery, but conservative laparoscopic intervention is a viable approach for preservation of fertility.

Receptores de estrógeno e progesterona em células do sedimento de fluido peritoneal na endometriose pélvica: estudo imunocitoquímico

Objetivo: avaliar a expressão de receptores de estrógeno (RE) e progesterona (RP) em esfregaços de sedimento de fluido peritoneal em pacientes com endometriose, comparando-a com a de mulheres sem endometriose. Métodos: foi realizado imunocitoquímica para RE e RP em esfregaços de sedimento de fluido peritoneal em 19 casos de endometriose e 7 sem endometriose (controle). Os dados foram submetidos ao teste t de Student para análise estatística. Resultados: em 84,6% dos casos de pacientes com endometriose, células tipo endometrial expressaram RE, numa média de 4,1%, ao passo que nos casos sem endometriose foi positivo em 42,9%, com uma expressão média de 4,5% (p = 0,1706). RP foi expresso apenas em um caso, com endometriose, com história de rotura de endometrioma. Conclusões: não houve diferença da expressão de RE entre os casos de endometriose e os casos-controle, observando-se um comportamento distinto em tecidos. Um mais aprofundado estudo deve ser feito para melhor avaliar o enigmático mecanismo envolvido na manifestação de receptores hormonais em células esfoliadas.

Rupture of an ovarian endometrioma during the first trimester of pregnancy

Rupture of an ovarian endometrioma presenting as a surgical emergency during pregnancy is a rare event. We report the first case to our knowledge of growth and rupture of an endometrioma in the first trimester of pregnancy. After laparotomy, the postoperative course was uneventful and the pregnancy is ongoing.