TWISTED OVARAIN CYST:AN EMERGENCY

A 30 year old lady presented with intermittent acute pain in right iliac fossa since 3 days. The pain was severe and needed administration of Fortwin and Phenergan for the pain relief.

The In House Gynecologist checked the patient.There was tenderness in right iliac fossa   but as such the P/V and per-speculum examination was normal.

Her menses had just begun so the congestive pelvic pathology was also suspected. Accordingly antibiotics and anti-inflammatory medications  were started.    

She underwent imaging and essential biochemical and hematological tests. There was a 8 cm right adnexal cyst with intact flow( on Doppler test).

We did a contrast enhanced CT scan for the anatomical delineation of the cyst and its relationship with the adjacent organs.

CT revealed right hydro-ureteronephrosis and bilateral small calculi .The ureteric dilatation was till the right pelvic brim.  The wall of the cyst was thick.

We took her for laparoscopic cystectomy. The patient  had undergone three surgeries( two LSCS and one open appendecictomy).As we suspected right ureteric encroachment by the cyst and pericystic inflammation ; we pre-stented the right ureter.  

There were a plenty omental and intestinal adhesions.We had to do the adhesiolysis first to reach the pelvis.

The ovarian cyst was twisted along with the ovary.The cyst was appearing   tense with bluish hue( haemorrhagic).We removed the cyst in toto and concluded the surgery by doing the ovariopexy to lateral pelvic wall.

The surgery was uneventful.The cyst wall was sent for histopathological analysis.