P17.05: Two cases of spontaneous rupture of endometrial cyst in non‐pregnant state

Spontaneous rupture of endometrial cyst (endometrioma) in non-pregnant state is very rare and presents as an acute abdomen. We are presenting two such cases with no history of typical dysmenorrhoea suggesting endometriosis. Thirty one years old, unmarried, nulligravida woman presented with acute abdominal pain followed by vomiting and abdominal distension. Ultrasound revealed free fluid in peritoneal cavity with good peristaltic bowel movements and bilateral ovarian cyst with normal uterus. There was no free gas under diaphragm. She progressively deteriorated with increasing distention and operated on 3rd day of pain. She was Pakistani traveller and surgical intervention delayed due to delay in consent. Another 30 years old primipara lady presented with complain of acute abdominal pain in LIF followed by nausea and vomiting. Ultrasonography revealed free fluid in form of vertical collection in POD, with 31 X 31 mm size left ovarian cyst with few internal echoes and probe tenderness. She was managed conservatively considering haemorrhagic corpus luteal cyst. But symptoms persisted. After 20 days of pain, there was 6 X 3 cm encysted echogenic fluid collection in POD. Uterus was pushed anteriorly and tender on examination. She was operated laparoscopically. Left ovary and tube found adherent with posterior surface of uterus with endometriosis and encysted fluid collection between sigmoid, rectum, left pelvic wall and uterus which was walled off by omentum cranially. Both cases managed laparoscopically successfully with uneventful post-operative outcome. Diagnosis of endometriosis was confirmed by histopathological examination.