Torsion Of Ovarian Cyst Research Articles

Peripubertal ovarian cyst torsion as an early complication of undiagnosed polycystic ovarian syndrome

The aim of the authors is to present two cases which raise the possibility of an association between polycystic ovarian syndrome/hyperandrogenism and ovarian cyst torsion in peripubertal girls. Androgen excess may cause more frequently ovarian cyst formation in premenarcheal or young adolescents with undiagnosed polycystic ovarian syndrome than in adults. The authors recommend that polycystic ovarian syndrome as well as late onset congenital adrenal hyperplasia should be considered in peripubertal adolescents with ovarian cyst torsion. In case polycystic ovarian syndrome is confirmed, adequate management according to age and pubertal development of the patients should be commenced.

腹腔鏡下手術によって確定診断に至った卵管捻転・卵管留血腫の一例

A premenarcheal 11-year-old girl with no experience of sexual intercourse had repeated lower abdominal pain since she was 7 years old. Imaging and blood tests on her first visit to our hospital showed no abnormal findings. However, she continued to experience intermittent right lower quadrant abdominal pain, and a year and a half later, presented with severe right lower abdominal pain. Transabdominal ultrasound examination and pelvic contrast MRI showed a pelvic mass of 10cm diameter with no blood flow to the right adnexal area. We suspected torsion of ovarian cyst, and performed laparoscopic surgery to obtain a definitive diagnosis. Laparoscopic surgery showed that her uterus and bilateral ovaries were normal in appearance, but only a stump of the left fallopian tube remained, and the right fallopian tube was twisted 1440 degrees. We performed right salpingectomy, and she was discharged three days after the surgery. Case reports of fallopian tube torsion or oviduct edema in women with no experience of sexual intercourse can be found in the literature, and laparoscopic examination should be considered for minors with repeated lower abdominal pain.

CT diagnosis of ovarian cyst torsion in children

CT diagnosis of ovarian cyst torsion in children

Preoperative differentiation between tumor‐related ovarian torsion and rupture of ovarian cyst preoperatively diagnosed as benign: A retrospective study

Patients with ovarian cyst sometimes present with acute abdomen caused by ovarian torsion or rupture, which are difficult to differentiate preoperatively. The purpose of this study was to determine preoperative features of patients with ovarian cyst that could be used in differentiation. Among 1723 patients with a preoperative diagnosis of benign ovarian cyst who underwent surgery between 1995 and 2010, 77 patients with ovarian torsion and 21 patients with ruptured ovarian cyst were retrospectively evaluated. The mean preoperative age, serum C-reactive protein (CRP) level, white blood cell count, body temperature, cyst size, and rate of acute abdomen were compared between the two groups, and postoperative pathological data were also collected. There were significant differences between the torsion and rupture groups in the mean preoperative CRP levels (0.9 mg/dL vs 6.6 mg/dL, respectively; P<0.01) and in the mean ovarian cyst sizes (9.7 cm vs 6.7 cm, respectively; P=0.04). In this study, the patients with ruptured ovarian cyst had elevated CRP levels. Another study has demonstrated that there was risk for necrosis in torsion patients with elevated CRP levels who presented more than 10h after the onset of acute abdomen. Therefore, preoperative differential diagnosis between ovarian torsion and rupture may be possible by combining the findings from preoperative imaging, data on the time from onset of acute abdomen, and CRP values.

A clinical analysis on laparoscopic surgery for torsion of ovarian cysts with ovarian preservation

Objective To explore the clinical features and efficacy of laparoscopic restoration of torsed varian cysts and then removal of the cysts following ligation of ovarian veins.Methods We analyzed the clinical data on 38 women who had been hospitalized and had received laparoscopic surgery for torsion of ovarian cysts with ovarian preservation during the period of May 2007 to May 2011.Results The time period from the onset of ovarian cyst torsion to the beginning of surgical treament was 4 to 72 hours.After the laparoscopic surgery,the blood supply,shape,and endocrine function of the ovary were rapidly restored.Four of the women were successfully pregnant and finally gave birth.Conclusions Laparoscopic restoration of torsed varian cysts and then removal of the cysts following ligation of ovarian veins is a less invasive,simple,feasible,safe,effective procedure.It is worth trying in clinical practice. Key words: Laparoscopy; Ovary; Torsion

Extensive peritoneal calcification and small intestinal perforation in a peritoneal dialysis patient: A case report

A 56-year-old woman was maintained on continuous ambulatory peritoneal dialysis (PD) for 12 years. The patient presented to our hospital with chief complaints of intermittent abdominal pain and frequent loose stool. Plain radiograph of abdomen revealed extensive peritoneal calcification. Computed tomography confirmed the extensive peritoneal calcification and revealed a large right ovarian cyst. Torsion of the right ovarian cyst was suspected. Right oophorectomy was performed. Small intestinal perforation developed 37 days after the operation. The patient expired because of peritonitis and sepsis. Extensive peritoneal calcification is a rare and serious complication after long-term PD. Intestinal perforation is a rare complication of PD. Pathognomic signs of imaging studies can be important in early diagnosis and treatment.

Ovarian cyst torsion in a patient with congenital lipoid adrenal hyperplasia

Congenital lipoid adrenal hyperplasia (CLAH) is the most severe form of congenital adrenal hyperplasia, characterized by lack of synthesis of all gonadal and adrenal steroid hormones. Ovarian cysts can develop as complications of CLAH. However, the precise mechanism of development and natural history of such cysts in patients with CLAH have not yet been determined. We recently treated a 14-year-old female patient with CLAH and ovarian cyst torsion. As a neonate, she presented with vomiting, skin pigmentation, and electrolyte imbalance. At that time, her serum adrenocorticotropic hormone concentration was elevated, while 17-hydroxypregnenolone level was normal, as were her normal female external genitalia. Mutation analysis showed that she was homozygous for p.Q258X in the StAR gene. She underwent spontaneous puberty and menstruation. At 14 years of age, she received salpingo-oophorectomy because of ovarian cyst torsion presenting as acute pelvic pain. Ovarian cysts are important clinical manifestations in 46,XX patients with CLAH, although onset time and severity can vary depending on individuals. Thus, patients with CLAH should be carefully monitored for ovarian complications to preserve as much ovarian function as possible.

Ovarian cyst torsion coexisting with acute pyelonephritis in an eight‐year‐old premenarchal girl

We report the case of a premenarchal eight-year-old girl with an adnexal torsion accompanied by acute pyelonephritis with vague, non-specific symptoms. In young girls, symptoms may be vague, with patients complaining of non-specific gastro-intestinal problems. Combination with other complications such as pyelonephritis makes the diagnosis of adnexal torsion even more difficult as in the present case. To preserve future reproductive function, early surgical intervention is required. Although the impact on menarchal development of oophorectomy or partial removal of ovarian tissue before menarche remains to be evaluated, timely recognition and treatment of adnexal torsion clearly increases the possibility of retaining the ovary. Therefore, to decrease the time between the onset of symptoms and the identification of patients at risk, sonography should be considered as a first imaging modality for evaluating children with any degree of abdominal pain accompanied by non-specific symptoms.

OP11.06: Role of 3D power Doppler in early diagnosis of massive ovarian edema due to incomplete torsion of a simple ovarian cyst

OP11.06: Role of 3D power Doppler in early diagnosis of massive ovarian edema due to incomplete torsion of a simple ovarian cyst

Torsion of ovarian cyst during pregnancy: a case report

In this case we report a 23 -year-old primigravida with 30 weeks presenting with torsion of the ovarian cyst. She presented to the antenatal clinic with acute pain abdomen. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy was carried out. Her histopathology report showed a benign serous cystadenoma. Her pregnancy was followed up. She delivered a healthy female baby at term. Although the safety of antepartum surgical intervention has been accepted, abdominal surgery nevertheless carries some risks to a pregnant woman and unborn fetus, and so the choice of management necessitates a weighing of risks based on characterization of the adnexal mass and gestational age.

DERMOID CYST OF OVAR

The patient was a 23 years unbooked primigravida who presented through emergency with the history of gestationalamenorrhea of 12 weeks and acute pain in the left iliac fossa for the last 3 hours. Urgent ultrasound revealed viable pregnancy of 12 weeksalong with a large left ovarian cyst of heterogenous echogenicity. A diagnosis of torsion of right ovarian cyst was made and immediatelaparotomy was done after counseling of the family and preparing the patient. Per-operatively, it was found that left ovarian cyst had undergonetorsion. Histopathology confirmed the diagnosis of dermoid cyst.

1269: Percutaneous US-guided Aspiration of Asymptomatic Neonatal Ovarian Cyst Torsion: A Case Report and Literature Review

Ovarian cysts are common incidental findings in term infants and, when unusually large, may result in torsion, rupture, or intestinal obstruction. Treatment options include conservative management, antenatal or neonatal cyst aspiration and laparoscopic surgery. We report a case of US-guided aspiration for the treatment of neonatal ovarian cyst with an intra-uterine torsion. A female infant was vaginally delivered at 41 weeks of gestation and a large abdominal cyst (approximately 4.4 cm in diameter) with a fluid-debris level was detected on the antenatal and neonatal sonographies. She was healthy with no sign of acute abdomen. Percutaneous US-guided fine needle aspiration was performed for the cyst on the 3rd day after birth and approximately 10 ml of dark red colored fluid was aspirated. The cyst was significantly decompressed, and the diameter was decreased by half. Gradual increase of the cyst size up to 3.2 cm in diameter was detected on the successive follow-up ultrasonograms until the baby was 2 months old, and thereafter, gradual decrease until 1yr old. On the last ultrasonographic examination, the cystic component disappeared completely and an approximately 1.5 cm sized ovoid nodule like structure with peripheral tiny anechoic dots seemed like a normal ovary was demonstrated. US-guided aspiration could be a treatment of choice for a large asymptomatic neonatal ovarian cyst torsion and expect a good result even though the cyst shows transient growth by fluid refilling.

Ovarian cyst torsion in a toddler

Acute abdominal pain in children is encountered frequently, and the differential diagnosis is extensive. Acute ovarian torsion in children is rare, especially at a very young age, and a difficult diagnosis to make. Infarction caused by ovarian torsion will result if the twist is not unwound spontaneously or surgically in a timely fashion. We presented a case of acute ovarian cyst torsion in a 2-year-old girl who originally presented to the emergency department with abdominal pain and vomiting. Ultimately, she was found to have a 2-cm cyst of the right ovary with concomitant torsion. Because acute ovarian torsion in a very young child is not encountered frequently, timely diagnosis is required to prevent mortality and minimize morbidity. It is important to keep ovarian torsion in the differential of any female children with acute abdominal pain. Emergency physicians should be aware that the potential of acute ovarian torsion in a very young child has a high index of suspicion and seek early operative intervention.

Torsion of a benign ovarian cyst in the third trimester of pregnancy: a case report

Abstract Adnexal torsion in advanced pregnancy is an uncommon emergency. It is uncommon for a normal-sized ovary to undergo torsion in advanced gestation. Presenting symptoms include severe abdominal pain, followed rapidly by maternal shock and fetal distress. A 34 years-old woman at 34 weeks gestation (gravida 5, para 4) was admitted with abdominal pain, vaginal bleeding, fever, and vomiting. On examination, in the right lower abdomen, an amorphous, predominantly hyperechogenic mass was found. Laparotomy revealed, however, that the right ovary was gangrenous and had undergone torsion. Adnexal torsion should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation. An early diagnosis using Doppler ultrasonography of the adnexa will enable early intervention to prevent maternal shock and fetal distress. Keywords: Torsion, ovarian cyst, pregnancy Ozet Ileri gebelikte adneksal torsiyon nadir bir acil durumdur. Buyuk gebeliklerde normal bir overind torsiyona ugramasi zordur. Olgu siddetli karin agrisi ve bunu izleyen hizli maternal sok ve fetal distress ile basvurdu. Anne, 34 yasinda, gravida 5 parite 4, karin agrisi, vajinal kanama, ates ve kusma ile Kabul edildi. Muayenede sag alt kadranda duzensiz sekilli, daha cok hiperekojenik olan bir kitle bulundu. Laparatomide sag overin torsiyona ugramis ve gangranoz oldugu saptandi. Ileri gebelikte alt karin agrilarinin ayirici tanisinda adneksal torsiyon da dusunulmelidir. Adnekslerin Doppler ultrasonografisi erken tanida yardimci olarak maternal sok ve fetal distresi onleyebilir. Anahtar sozcukler: Torsiyon , over kisti, gebelik

A case report of a complicated fetal ovarian cyst

Fetal ovarian cysts represent cystic lesions confined to the lower abdomen of a female fetus, when the stomach, bladder and both kidneys appear normal. We report on a rare case of a complicated fetal ovarian cyst measuring approximately 5cm detected at 34 weeks gestation. Based on the sonographic features a diagnosis of a complicated fetal ovarian cyst (either torsion or haemorrhage or both) was made. A haemorrhagic fetal ovarian cyst and possible torsion was confirmed post delivery at surgery and an oophorectomy had to be performed. Ovarian cysts greater than 4 cm are prone to complicate resulting in compromise of this organ system. Decompression of cysts > 4cm in fetuses remote from term may reduce the complication rate of these larger fetal ovarian cysts. An approach to the diagnosis and management of fetal ovarian cysts is presented. O & G Forum Vol. 18 (3) 2008: pp. 97-100

P26.07: Prenatal sonographic follow‐up of the changes related to a fetal ovarian cyst torsion

P26.07: Prenatal sonographic follow‐up of the changes related to a fetal ovarian cyst torsion

GYNAECOLOGICAL EMERGENCIES

in all the patients. More specific investigations were performed where required. All the patients were resusscitated and operative treatment; where required; was performed under general anesthesia at the earliest possible time. The surgical procedure was tailored according to the circumstances. Further management, conservative or post operative care was done in surgical ward. Results: Pelvic Inflammatory Disease (PID) which is the inflamation of upper genital tract with its complications like pelvic cellulitis and pelvic peritonitis was the most common (40.9%) emergency. The age group between 16 to 30 years was the commonest having gynaecological problems. There was a clear predilection of married than unmarried females facing these problems. Because of lack of experience and limited diagnotistic facilities erroneous diagnosis was made to some extent in almost all the cases. 55.55% of patients suffering from PID were treated successfully by conservative means. Surgical procedurewas performed in all the patients (100%) suffering from ruptured ectopic pregnancy, perforated uterus and torsion of ovarian cyst and pedunculated subserosal fibroid. Wound infection and delayed wound healing were among the most common postoperative complications. Mortality occurred in ectopic pregnancy (16.66%) and PID (5.55%). Conclusion: The different gynaecological problems are commonly encounteredin general surgical practice. The surgeons often fall in this un-wary trap because of (1) close resemblance of clinical features (2) less exposure to gynaecological problems (3) non availability of more sophisticated diagnostic tools in emergency. The overall sufferings of patients can be reduced to some extent by overcoming these shortcomings.

Ovarian cyst torsion and extreme ovarian stimulation in a premenopausal patient treated with tamoxifen for ductal carcinoma in situ of the breast

Tamoxifen is increasingly used in adjuvant endocrine therapy for postsurgery breast cancer patients and in chemoprevention for high-risk patients. We present a case of bilateral ovarian cyst development with consecutive unilateral cyst torsion and elevated serum estradiol in a premenopausal patient treated with tamoxifen after breast-conserving surgery.

Pedicle Torsion of Ovarian Cyst and Acupuncture – a Case Report

A case history is reported of a patient who presented with acute pedicle torsion in a left ovarian cyst, which had been diagnosed seven months previously. The diagnosis was established by sonography. She declined surgery for personal reasons, and was treated with acupuncture. Her pain was successfully relieved, and she continued to be observed. The acupuncture was repeated daily for 15 days, after which time repeat sonography showed reduction in size of the cyst, and no torsion of the pedicle. No relapse had occurred at 16 months follow up.

Prise en charge cœlioscopique des masses latéro-utérines pendant la grossesse

To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy.and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique.The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases.Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.