Spontaneously Ruptured Endometriotic Cysts-A Case Report

II. Case Report A 24 year old nulligravida presented to the Goa Medical College with chief complaints of noticing mass per abdomen since two months and progressively worsening dysmenorrhoea since one year on 8/7/2015.She was afebrile, normotensive with no tachycardia and per abdomen she had a mass palpable reaching up to the umbilicus which was cystic in consistency and non tender. She presented with severe abdominal pain and vomiting in a peripheral health centre on 14/7/2015. Subsequent to this episode, the patient continued to have dull aching pain which was however significantly less. She then presented to our OPD a week later wherein there was a significant reduction in the size of the ovarian mass and surprisingly no signs of acute abdomen! The preoperative investigations done showed haemoglobin of 11.2g% (before and after the rupture).the patient had a total count of 7,200 and a CA 125 of 3000.2 IU/ml preoperatively. The ultrasonography of the abdomen and pelvis done after suspected rupture on 22/7/15 showed a large cyst 11*7.3*7.2cm with thick walls and densely packed internal echoes noted in the right ovary. The uterus and left ovary were normal. There was no evidence of hemoperitoneum. There was a reduction in the size of the cyst however compared to the prior USG. The patient underwent a laparoscopic bilateral endometriotic cyst excision with ablation of the endometriotic deposits with adhesiolysis under general anaesthesia on 24/7/2015. The intraoperative findings were suggestive of a ruptured right sided endometriotic cyst 8 * 10 cm, adherent to the posterior surface of the uterus and the pouch of Douglas. Spillage of chocolate colored fluid was noted over the entire peritoneal cavity including the undersurface of the diaphragm as well as the omentum. Surprisingly there was no hemoperitoneum. A 4*3 cm left sided endometriotic cyst was also present. The uterus was retroverted. Subsequently, the histopathological report revealed an endometriotic cyst.