Case presentation on ovarian cyst #ovarian cyst #obs & gynae case presentation #obs & gynae #Obstetrics #Gynaecology #obs #gynae #case presentation #mbbs #ppt #gynaecology_case_presentation

1. Presented By
MD ASHIK BILLA BAIDYA
SAMPRIKTA NAYAK
RATNADIPA RUDRA PAL

2. CASE SCENERIO
 A 36 Years old female patient came to an
OPD with a chief complain of pain abdomen
with irregular bleeding for 10 days.

3. History of Present illness-
 Dull aching pain on lower abdomen for last 10 days.
 Heaviness in lower abdomen
 Irregular bleeding occur but there is no clots passed
during menstruation.
 Painful constipation(Dyschezia) around the time of
period.
 Dysuria(painful micturition) during the periods.
Menstrual History- LMP- 01/10/22
Obstetric History- P(1+0) Viable, Normal Delivery & No
complication during child birth.
LCB(Last Child Birth)- 4Yrs Back.
Past History- No history of any drug allergy, DM/HTN, Surgical
complications and any malignancy.
H/o contraception pill practice.

4. Examination-
General & Systemic examination- All within the normal
range. BMI- 30.6
Abdominal examination- No scar mark. Everted umbilicus.
A big lump on palpation which is mobile, smooth,
unilateral, slow growing.
Speculum examination- Normal cervix and vagina
Bimanual examination- Uterus- normal size, Retroverted,
consistency, mobility and tenderness.

5. Investigation Procedure-
 USG- It shows- i) Right ovarian cyst ii) Left Adenexal
cyst- ? Chocolate Cyst.
 CECT- A large cyst measures 11.8 x 7.2 cm is seen
anterior to uterus probably left ovarian origin. It does
not show any solid enhancing component.
Relatively smaller sized cyst is seen in relation to right
ovary measuring 4 x 3.2 cm.
 Tumor Marker- CA-125
 Pregnancy Test- If +ve test, there be corpus luteum cyst
 MRI

6. Provisional Diagnosis- It may be
“ADENEXAL CYST- LEFT OVARIAN CYST”
A collection of fluid filled sac or pocket within or on the
surface of an ovary.
It is shown as Suprapubic Lump.

7. Differential Diagnosis-
 Full Bladder
 Fibroid
 Pregnancy
 Chocolate Cyst of Ovary
JUSTIFICATION-
 Since the patient is seen after passing urine, then the
suprapubic lump is not full bladder.
 The lump is mobile, soft, firm. If it is fibroid then it can
be hard, immobile.
 The patient is not Amenorrheic, so that’s why she has
no chance of pregnancy
If pregnancy test is +ve occur, it may be ‘Corpus Luteum
Cyst’

8. TYPES OF OVARIAN CYST:
 FUNCTIONAL OVARIAN CYST- 1) FOLLICULAR CYST
2) CORPUS LUTEUM CYST
 PATHOLOGICAL OVARIAN CYST- 1) DERMOID CYSTS
2) CYSTADENOMAS
3) ENDOMETRIOMAS

10. Complication of these-
 Torsion of the pedicle
 Rupture
 Intracystic Hemorrhage
 Infection
 Infertility
 Ovarian Cancer

11. Management & Treatment-
Treatment will depends upon the – a) nature of mass
b) age of women
Conservative Management-
 It is Ideal for a patient- simple, unilateral and unilocular
ovarian cyst. low RMI- <8cm. Serum CA-125 Normal.
Such women are followed up with TVS at an interval of
4 months.
 Hormonal Birth Control Pills
 Analgesic- NSAIDS, Opiods.

12. Surgical Management-
 Once the ovarian cysts diagnosed, the patient should be
admitted for operation as sooner the better.
 GUIDELINES-
 Incision
 To inspect the nature of peritoneal fluid.
 To deliver the tumor intact
 To proceed
 To cut the tumor and then inspect side for any
malignancy.
 It is not prodent to bisect the contralateral ovary, if it
looks normal.

13.  LAPAROTOMY followed by removal of ovarian cyst is the
definitive surgery.

14. Post-operative diagnosis-
 Vitals check
 Urine Input & Output
 Hemorrhagic cyst with clots
 Findings- Normal right ovary, uterus and upper
abdomen.
 After a laparoscopy, it may take some time to resume
its normal activity.

15. Post- operative complications-
1) Mild pain and discomfort in lower tummy
2) Small amount of Vaginal bleeding for upto 48 hours.
3) Feeling tired for few days
 Patient to be discharged with oral hydrations and
analgesia
 Appointment for tracing histopathology after 6wks.
“Overall the Prognosis was Good”

16. THANK YOU