Complications Of Ovarian Cyst

Ovarian Cyst: Complications- Details on Torsion Of Ovarian Cyst

Ovarian Cysts are ono-neoplastic enlargement of Ovaries with accumulation of fluid inside the functional unit of Ovary. Cysts may be functional or Non-functional.  The Complications of Ovarian Cyst are:

Infection

Intracystic Hemorrhage

Rupture

Pseudomyxoma peritonei

Malignancy- Cancer

Torsion of the Pedicle.

Torsion Of Ovarian Pedicle or Twisted Ovarian Cyst:

Among the complications of these Ovarian cysts, Torsion of ovarian pedicle may cause the patient to present in Emergency in Acute painful condition and in Distress. Although it is often referred as Torsion of Cyst, actually it is the torsion of the cyst pedicle.
Torsions are more common in Serous Cysadenomas  and dermoid cysts. Axial rotations are seen in 10-15% cases at OT.

The Structures Forming Pedicle for Torsion are:

• Laterally – Infundibulopelvic ligament containing ovarian vessels, nerves and lymphatics
• Medially- Ovarian ligament, Medial end of Fallopian tube, Mesosalpinx
• Middle- Broad Ligament

Causes – Etiology of torsion of Pedicle is obscure.

Predisposing factors are: –

1. Trauma
2. Violent Physical movements
3. Contraction Of Pregnant Uterus
4. Intestinal peristalsis

Precipitating Factors:– Hemodynamic theory suggests that  slight axial rotation that leads to venous occlusion causes cyst to rotate with each arterial pulsation. It may get untwisted spontaneously or  few cases cyst may rupture and cause crisis situation.

Symptoms:-

• Varies with severity.
• In completely occluded cases, severe pain is the complaint.
• Lump may be feltper abdomen.
• Patient is in agony but general condtion is fair.
• Abdominal tenderness +, tense cystic mass, restricted mobility, usually in hypogastrium and arising from pelvis
• Pelvic examination reveals that the mass is separate from the uterus.

Differential Diagnosis:

1. Disturbed Ectopic gestation
2. Acute Hydramnios
3. Perforating mole
4. Torsion of Fibroid

Treatment:

Supress pain with Morphine 15mg IM

Laparotomy followed by Salpingoophorectomy ( Ovariotomy)

Source: DC Dutta Gynecology.