Ruptured Ovarian Cyst of Corpus Lutuem
-
Goal of evaluation = exclude ruptured ectopic pregnancy & decide if
conservative or surgical mx
- Cyst rupture can be uncomplicated or complicated; asymptomatic or symptomatic; benign or malignant.
Clinical Features
Symptoms
· Sudden onset, unilateral lower abdominal pain
· Bleeding diathesis, oral anti-coagulants – ↑ risk haemorrhagic ovarian cyst
NOTE: benign cyst = unilocular, thin walled. malignant cyst = multilocular
Signs
· May have not much signs
· Vitals: usually normal, ± low grade fever
· Abdo: Unilateral abdominal tenderness (RLQ commonly); ± Peritonitis; ± Cullen sign (i.e. periumbilical ecchymoses) with intrabdominal haemorrhage
· VE: ± Cervical motion tenderness; ± Adnexal mass (if cyst not completely ruptured)
Ddx
- **Exclude ruptured ectopic pregnancy!
- Mittleschmerz, ectopic pregnancy, ovarian torsion, degenerating fibroids, PID, acute endometritis, other abdo causes
Investigations
Others:
Treatment
Uncomplicated cyst rupture
Complicated cyst rupture
· Significant haemoperitoneum
o Admit to hospital, IV fluids, frequent vital signs, repeat imaging monitor bleeding
o ± emergency surgery to control ongoing significant haemorrhage if unstable/deteriorating+ frozen section of ovarian neoplasm
· If ovarian malignancy suspected → refer to gynae oncology
Features
- Uncomplicated cyst rupture:
o Features: Absence of hypotension/tachycardia/fever/acute abdomen signs/leukocytosis/US no enlarging haemoperitoneum or malignancy findings
o Most commonly follicular or corpus luteum cyst
o If large/persistent/findings suggestive of malignancy may need surgical interventions
Source
A/Prof Amanda Dennis 2014
Uptodate 2014 (evaluation and mx of ruptured ovarian cyst)
- Cyst rupture can be uncomplicated or complicated; asymptomatic or symptomatic; benign or malignant.
Clinical Features
Symptoms
· Sudden onset, unilateral lower abdominal pain
- Onset often during strenuous physical activity e.g. physical activity, sexual intercourse
- Light PV bleeding (∵ ↓ ovarian hormone lvl)
· Bleeding diathesis, oral anti-coagulants – ↑ risk haemorrhagic ovarian cyst
NOTE: benign cyst = unilocular, thin walled. malignant cyst = multilocular
Signs
· May have not much signs
· Vitals: usually normal, ± low grade fever
· Abdo: Unilateral abdominal tenderness (RLQ commonly); ± Peritonitis; ± Cullen sign (i.e. periumbilical ecchymoses) with intrabdominal haemorrhage
· VE: ± Cervical motion tenderness; ± Adnexal mass (if cyst not completely ruptured)
Ddx
- **Exclude ruptured ectopic pregnancy!
- Mittleschmerz, ectopic pregnancy, ovarian torsion, degenerating fibroids, PID, acute endometritis, other abdo causes
Investigations
- b HCG – serum or urine
- FBC
- *U/S
- Urine analysis + M/C/S
- Pyuria if urinary system inflammed from adj adnexal process e.g. ruptured ovarian cyst; haematuria – stone/infection
Others:
- Blood type + cross match if peritoneal signs/haemodynamically unstable
- Blood, urine culture; cervical cultures for STI – rule out pelvic or urinary tract infection (if febrile ± peritoneal signs)
Treatment
Uncomplicated cyst rupture
- Can manage as outpatient
- Reassurance (will self resolve)
- Non-haemorrhagic cyst fluid usu resorbed within 24 hours, sx resolve within few days
- Oral analgesia
- Rest
- Rescan in 6/52
- If large/persistent/findings suggestive of malignancy may need surgical interventions
Complicated cyst rupture
· Significant haemoperitoneum
o Admit to hospital, IV fluids, frequent vital signs, repeat imaging monitor bleeding
o ± emergency surgery to control ongoing significant haemorrhage if unstable/deteriorating+ frozen section of ovarian neoplasm
· If ovarian malignancy suspected → refer to gynae oncology
Features
- Uncomplicated cyst rupture:
o Features: Absence of hypotension/tachycardia/fever/acute abdomen signs/leukocytosis/US no enlarging haemoperitoneum or malignancy findings
o Most commonly follicular or corpus luteum cyst
o If large/persistent/findings suggestive of malignancy may need surgical interventions
Source
A/Prof Amanda Dennis 2014
Uptodate 2014 (evaluation and mx of ruptured ovarian cyst)