Ovarian Cyst Complications

Question 1

What are the complications of ovarian cysts?

Answer 1

Torsion
Haemorrhage (within the cyst)
Rupture (with bleeding into the peritoneum)

Question 2

What is ovarian torsion?

Answer 2

Twisting of the ovary its vascular and ligamentous supports, blocking adequate blood flow to the ovary

Question 3

What are the causes of ovarian torsion?

Answer 3

Ovarian mass >5cm (cyst, tumour)

Question 4

Presentation of ovarian torsion

Answer 4

Severe, sudden onset, abdominal pain (that doesn’t settle with analgesia)
N+V
Abdominal mass
Localised tenderness

Question 5

Findings on TVUS in ovarian torsion

Answer 5

“whirlpool” sign

Oedema of the ovary

Question 6

What investigation gives a definitive diagnosis of ovarian torsion?

Answer 6

Laparoscopic surgery

Question 7

Treatment for ovarian torsion

Answer 7

Surgical emergency
Detorsion:
If blood flow returns = cystectomy
Infarcted ovary = oophorectomy

Question 8

What can cause an ovarian cyst rupture?

Answer 8

Rupture can be spontaneous or after trauma (sexual intercourse, contact sports)

Question 9

Presentation of ovarian cyst rupture

Answer 9

Severe, sudden onset, abdominal pain
Shoulder tip pain (bleeding into the peritoneum causing irritation of the diaphragm)
Responds to analgesia (haemorrhage causes irritation which can settle with analgesia)

Question 10

Possible treatments for ovarian cyst rupture

Answer 10

Conservative
Resuscitation
Laparoscopy
Lavage = blood is causing pain due to irritation of the pelvis
Diathermy = stop bleeding
Oophorectomy = if the bleeding is really severe